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Objective: To compare the application effects of thoracoscopic assisted anterior mediastinal tumor resection by lateral thoracic approach or subxiphoid approach. Methods: According to the random number table method, 115 patients undergoing thoracoscopic assisted anterior mediastinal tumor resection were divided into group A (n=57, lateral thoracic approach) and group B (n=58, subxiphoid approach). The perioperative related indexes, stress response indexes and inflammatory factors were compared between two groups, and the occurrence of postoperative complications was observed. Results: Compared with group A, group B had longer operation time, less intraoperative blood loss and postoperative drainage volume, shorter postoperative hospital stay and drainage tube indwelling time (P<0.05). 1 day after operation, neuropeptide Y (NPY), 5-hydroxytryptamine (5-HT), substance P (SP) and prostaglandin E2 (PGE2) in two groups increased, but group B were lower than those of group A (P<0.05). 1 day after operation, C-reactive protein (CRP), white blood cell count (WBC) and neutrophils increased in two groups, but group B were lower than those of group A (P<0.05). The total incidence of complications in group A was 12.28%, and that in group B was 6.90%, there was no difference between two groups (P>0.05). Conclusion: During thoracoscopic assisted anterior mediastinal tumor resection, although the subxiphoid approach takes longer than the lateral thoracic approach, which can reduce intraoperative injury, reduce stress response and inflammatory response, and promote postoperative recovery. [ABSTRACT FROM AUTHOR]