Abstract / Summary
Subxiphoid video-assisted thoracoscopic surgery (SVATS) is widely used for anterior mediastinal tumor resection, yet proximity to major vessels creates technical challenges. This study quantifies how the vertical distance between the tumor and the left innominate vein (LIV) predicts surgical difficulty. We retrospectively analyzed 146 patients undergoing SVATS extended thymectomy. Preoperative 3D CT reconstruction was used to measure the vertical distance from the tumor’s cranial pole to the LIV’s caudal margin. Multivariable regression and Receiver Operating Characteristic (ROC) analyses identified predictors for operative time and blood loss. Multivariable analysis confirmed Tumor-LIV distance as the sole independent predictor for prolonged operative time and a key predictor for increased blood loss ( P < 0.001). ROC analysis established a distance of ≤ 0 mm as the optimal threshold for high surgical difficulty, with an AUC of 0.722 for operative duration and 0.687 for blood loss. Patients in this high-risk group demonstrated significantly poorer perioperative outcomes ( P < 0.001). Preoperative proximity of anterior mediastinal tumors to the LIV serves as a decisive anatomical determinant of surgical complexity in SVATS. A vertical distance of ≤ 0 mm identifies a “high-risk” subset prone to prolonged operative duration and increased hemorrhagic risk. Routine 3D anatomical modeling is advocated to stratify patients preoperatively, ensuring tailored surgical planning and enhanced perioperative safety.