Background/Objectives: Total thymectomy is currently the gold standard operation for treating thymoma. However, recent studies have suggested the potential health consequences of thymus removal in adults, including possible increased autoimmune disease and all-cause mortality. In this context, we assess oncologic outcomes following total vs. partial thymectomy for early-stage thymoma. Methods: We identified patients diagnosed with WHO types A–B3 thymoma between 2010–2021 from a national hospital-based dataset. We excluded patients with stage II or higher disease, open resections and perioperative chemo-/radiation therapy. We stratified patients into total and partial thymectomy cohorts. We used propensity score matching to minimize confounding, Kaplan–Meier analysis to estimate survival, and Cox proportional hazards to identify associations. Results: Of 1598 patients with early-stage thymoma, 495 (31.0%) underwent partial and 1103 (69.0%) total thymectomy. Patients undergoing partial thymectomy were similar in sex (female 53.7% vs. 53.4%; p = 0.914), race (white 74.5% vs. 74.0%; p = 0.921), comorbidities (0 in 77.0% vs. 75.5%; p = 0.742), and tumor size (48.7 mm vs. 50.4 mm; p = 0.455) compared to total thymectomy. There were no differences in 30-day (0.8% vs. 0.6%, p = 0.747) or 90-day mortality (0.8% vs. 0.8%, p > 0.999), which persisted after matching. Moreover, 10-year survival was similar in both unmatched (p = 0.471) and matched cohorts (p = 0.828). Partial thymectomy was not independently associated with survival (aHR = 1.00, p = 0.976). Conclusions: In patients with early-stage thymoma, partial and total thymectomy were associated with similar short- and long-term outcomes. In light of recent attention to the role of the thymus gland, the results add important insights to shared decision-making discussions.

Background/Objectives: Preoperative pulmonary function tests (PFTs) contain numerous physiologic parameters, yet surgeons typically rely on forced expiratory volume in one second (FEV₁) and diffusing capacity of the lung for carbon monoxide (DLCO) to assess surgical risk. This study aimed to evaluate whether artificial intelligence (AI) could utilize more PFT data to predict the occurrence of prolonged air leak (PAL) following lung resection. Methods: An optical character recognition (OCR) model was used to extract structured data from PFT reports. These data were combined with clinical and demographic features from our institutional Society of Thoracic Surgeons General Thoracic Surgery Database (STS-GTSD) between 2016 and 2023. A feature selection algorithm was used to select the most predictive features, and a neural network was trained and tested on an internal validation cohort to predict PAL. Model performance was compared to previously published models. Results: There were 410 patients undergoing lung resection who had PFTs successfully digitized by the OCR system. A total of 76 available PFT features were extracted per patient. The final AI model included 10 key input variables, including three PFTs and seven clinical variables. On validation, the model achieved a specificity of 73%, sensitivity of 60%, overall accuracy of 72%, and an area under the curve of 0.74. This performance exceeded most existing PAL prediction models. Conclusions: AI-driven models using structured PFT and clinical data can enhance prediction of prolonged air leak after lung resection and outperform conventional regression-based models. Further research may focus on external validation and integration into clinical workflows.

Substernal goiters (SGs) with significant mediastinal extension can present complex surgical dilemmas. While most SGs can be resected through a low cervical collar incision, a full median sternotomy may be required in select cases. Morbidly obese patients are susceptible to adverse outcomes following full sternotomy, such as wound infection and sternal dehiscence. Partial upper sternotomy is a safe, effective alternative that offers sufficient access to the mediastinum while minimizing surgical morbidity, making it a valuable approach in this high-risk population. We present the case of a 33-year-old female with a BMI of 47 kg/m2 who was found to have a large symptomatic SG with significant mediastinal extension. Due to the depth of extension, a combined cervical and trans-sternal approach was planned. A partial upper sternotomy was performed to avoid the morbidity of full sternotomy. The patient tolerated the procedure well without complications and was discharged home on postoperative day two.