Analysis of surgical treatment of Masaoka stage III-IV thymic epithelial tumors

Hamanaka, Kazutoshi; Koyama, Tsutomu; Matsuoka, Shunichiro; Takeda, Teiji; Miura, Kentaro; Yamada, Kyoko; Hyogotani, Akira; Seto, Takashi; Okada, Kenji; Ito, Kenichi

doi:10.1007/s11748-018-0996-9

Cited by 11 publications

(11 citation statements)

References 9 publications

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“…Because SVC replacement is a technically challenging operation, even at a high-volume center, the management of locally advanced TETs is still a matter of debate among surgeons, oncologists, and radiotherapists. 10,11 The assessment of resectability depends mostly on the surgeon's judgment and experience but should be discussed by a multidisciplinary team for a more comprehensive overview. A meticulous preoperative workup allows accurate staging of the disease, functional evaluation of the patient, and planning of the surgical strategy.…”

Section: Commentmentioning

confidence: 99%

Outcomes and Safety Analysis in Superior Vena Cava Resection for Extended Thymic Epithelial Tumors

Bertolaccini

Prisciandaro

Galetta

et al. 2021

The Annals of Thoracic Surgery

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Section: Commentmentioning

confidence: 99%

Outcomes and Safety Analysis in Superior Vena Cava Resection for Extended Thymic Epithelial Tumors

Bertolaccini

Prisciandaro

Galetta

et al. 2021

The Annals of Thoracic Surgery

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“…However, it can be found that surgery plays an important role in the treatment of stage III thymic tumors. Studies have shown that complete resection is the most important prognostic factor for stage III thymic tumors ( 9 , 14 ). Therefore, resectability of all stage III thymic tumors should be evaluated preoperatively.…”

Section: Discussionmentioning

confidence: 99%

“…( 5 - 8 ). In general, however, surgical treatment is the preferred option for resectable lesions, as numerous studies have demonstrated that complete resection of the tumor is the most important prognostic factor for thymic tumors ( 5 , 9 , 10 ). With the advancement of minimally invasive surgery, doctors have used video-assisted thoracoscopy (VATS) ( 10 ), even robotic VATS ( 11 ), to remove stage III thymic tumors.…”

Section: Introductionmentioning

confidence: 99%

Video-assisted thoracoscopy versus open approach in patients with Masaoka stage III thymic epithelial tumors

Chen¹,

Xie²,

Lin³

et al. 2019

Transl. Cancer Res

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Background The treatment options for Masaoka stage III thymic epithelial tumors are diverse, mainly because the lesions infiltrate the neighboring organs, major vascular structures, with different scopes, extents, and manners. Surgical treatment is the main treatment for the patient in this stage. However, for minimally invasive or open surgery, the current controversy remains large. This study aimed to investigate the feasibility and indications of minimally invasive resection in the treatment of stage III thymic tumors. Methods Twenty-six patients with Masaoka stage III thymic tumors who underwent surgery were enrolled in the study. Among them, group A with 8 patients underwent thoracoscopic resection and group B with 18 patients (including one open-converted patient) underwent semi-sternotomy or full-sternotomy resection. The groups were compared with each other in terms of the characteristics of patients, tumors, and perioperative period. Results There were no significant differences in patients’ characteristics, WHO classification, and complications between the two groups (P>0.05), but the tumors in group B were significantly larger than those in group A (P<0.05). In group B, the lesions infiltrated the superior vena cava and the phrenic nerve more frequently than that of group A (P<0.05). There was no significant difference between the two groups in the involvement of left innominate vein, pericardium, and lung (P>0.05). Tumor size, the involvement of superior vena cava and phrenic nerve were important factors in the determination of minimally invasive surgery for Masaoka stage III thymic tumor (P<0.05). Conclusions For Masaoka stage III thymic tumors, neighboring organs involved were noted to be important factors in successful minimally invasive tumor resection. Tumor size and involvement of phrenic nerve and superior vena cava were found to be the variables that hindered successful video-assisted thoracoscopy (VATS) resection. Thus, minimally invasive resection is acceptable in the treatment of selected cases of Masaoka stage III thymic tumors.

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“…13,19 In bilateral graft cases, besides smaller size, attention needs to be paid on the matches of diameter of both graft vessels, preventing the occurrence of blood stealing, which could result in blood flow reduction in the small vessel and even thrombus formation. 20,21 Our experience for bilateral reconstruction is that the artificial vessel in 1.2 to 1.4 cm diameter is suitable to replace right BCVor SVC, and 1.0 to 1.2 cm fitting for left BCV. In addition, the diameter difference between the two grafts should be within 0.4 cm.…”

Section: Surgery Procedures Recommended and Grafts Selectedmentioning

confidence: 99%

Prosthetic Reconstruction of Superior Vena Cava System for Thymic Tumor: A Retrospective Analysis of 22 Cases

Zhang

Huang

Pan

2020

Thorac Cardiovasc Surg

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Objective This study aimed to report our experience in superior vena cava (SVC) resection and reconstruction for 22 thymic tumor patients and to make comparisons with previous related reports. Methods A retrospective study on 22 patients (15 thymomas, 7 thymic cancers) who underwent tumor resection with concomitant SVC reconstruction. All the patients underwent vascular conduit reconstruction by the cross-clamping technique. The corresponding data were reviewed, including clinical presentation, operation management (surgery procedure, selection of suitable graft, strategies against SVC syndrome, etc.), postoperative cares (antithrombotic agent application, treatments on brain edema, etc.), and follow-up information. Result Two patients were myasthenic, well controlled by oral pyridostigmine. All resections were radical (R0). Ten patients received induction treatment. All the 15 thymoma patients were Masaoka stage III (type B1–B3). As for thymic cancer, six patients were Masaoka stage III and one was stage IVa. Wedge pulmonary resection was performed in three patients (two right upper lobe, one both upper lobe). Procedures included were single graft replacement in 12 patients, bilateral grafts in 9, and Y-shaped graft in 1 patient. Anticoagulation and dehydration agents were routinely applied after operation. No perioperative mortalities were observed. Major complication rate was 9.1%. The median survival time was 44.2 months (range, 4–92 months). Three- and 5-year overall survival rates were 80.8 and 44.0%, respectively. As for conduit patency, two grafts (9.1%) demonstrated evidence of occlusion during long-term follow-up, but no additional interventions were required due to no complications related. Conclusion Our study, confirming data from existing literature, showed that the prosthetic reconstruction of the SVC system is a feasible additional procedure during resection of thymic tumor infiltrating the venous mediastinal axis, minimally increasing postoperative complications in experienced hands.

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Analysis of surgical treatment of Masaoka stage III-IV thymic epithelial tumors

Abstract: Patients with Masaoka stage III-IV thymic epithelial tumor showed relatively favorable long-term survival after surgical treatment. Therefore, aggressive surgical resection for complete resection may be a treatment option for these conditions.

Cited by 11 publications

References 9 publications

Outcomes and Safety Analysis in Superior Vena Cava Resection for Extended Thymic Epithelial Tumors

Outcomes and Safety Analysis in Superior Vena Cava Resection for Extended Thymic Epithelial Tumors

Video-assisted thoracoscopy versus open approach in patients with Masaoka stage III thymic epithelial tumors

Prosthetic Reconstruction of Superior Vena Cava System for Thymic Tumor: A Retrospective Analysis of 22 Cases

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