Could thymomectomy be a reasonable option for non-myasthenic thymoma patients?

Tassi, Valentina; Ceccarelli, Silvia; Zannori, Cristina; Gili, Alessio; Daddi, Niccolò; Bellezza, Guido; Ascani, Stefano; Liberati, Anna Marina; Puma, Francesco

doi:10.21037/jtd.2017.09.109

Cited by 14 publications

(14 citation statements)

References 37 publications

(95 reference statements)

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“…protocols have been developed yet. However, in order to achieve long-term survival rates, a radical surgical resection of the TC with no microscopic residual disease should be achieved whenever possible for stage III and stage IVa of the disease (2,3,12,13).…”

mentioning

confidence: 99%

Morphological assessment of thymic carcinoma through imaging: is computed tomography useful in selecting patients for surgery and in predicting incomplete resection?

Priola

2018

J. Thorac. Dis

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mentioning

confidence: 99%

Morphological assessment of thymic carcinoma through imaging: is computed tomography useful in selecting patients for surgery and in predicting incomplete resection?

Priola

2018

J. Thorac. Dis

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“…All guidelines and large retrospective review studies recommend the complete en bloc thymectomy as the current gold standard in all resectable thymic lesions because of the risk of a multicentric thymoma development, the occurrence of MG after the operation, and the prevention of the local recurrences [10,[73][74][75][76] . However, many authors have proposed the resection of the thymoma without the rest of the thymic gland as a feasible and safe resection in early stage thymomas (Stages I and II) without MG [77][78][79][80][81][82][83][84][85][86] [ Figure 7].…”

Section: Radicality: Thymomectomy or Thymectomy?mentioning

confidence: 99%

Standardized definitions and concepts of radicality during minimally invasive thymoma resection

Iaco¹,

Brascia²,

Geronimo³

et al. 2020

Mini-invasive Surg

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Radical thymectomy is the gold standard treatment for thymoma; in particular, completeness of surgical resection of a well-encapsulated thymoma and adequate margins are considered the most important prognostic factors. According to the International Thymic Malignancy Interest Group instructions, in fact, the thymus should be resected en bloc with its upper cervical poles and the surrounding mediastinal fat and through a no-touch surgical technique. For years, the open approaches have been considered the gold standard treatment for thymic masses, because of technical advantages and proved good oncological results. When applied to properly chosen patients on the basis of the tumor stage, dimension, and histology, minimally invasive approaches could be as effective as open ones in terms of long-term outcomes. To accomplish a minimally invasive thymoma resection, several minimally invasive techniques (transcervical, subxiphoid, thoracoscopic, and robotic) have been described, each presenting advantages and drawbacks. Moreover, when dealing with early stage neoplasms, many authors have proposed to perform the thymomectomy alone, not involving the rest of the thymic gland, but evidence is still imprecise and vague, and some studies have described a higher rate of local recurrence when using this technique. Finally, many studies suggest that surgeons with expertise in minimally invasive lymphadenectomy for lung cancer may easily endorse the idea of nodal dissection, to be performed at least in advanced thymomas involving neighboring structures, large masses, and thymic carcinomas.

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“…In case of ectopic thymoma or orthotopic tumor grown outside the mediastinum, the Masaoka stage can be even misleading; the principles of surgery for thymoma find in the complete removal of the thymus gland and the surrounding fat the basic procedure to be extended to the neighboring organs in case of infiltration [2]. For ectopic thymoma or orthotopic tumor grown outside the mediastinum, the treatment can be accomplished without total thymectomy [31]. We suggest to look for R0 instead of making a total thymectomy if the tumor is far detached from the thymus gland and to follow the patient up for a supposed enhanced risk of new primary thymic malignancies [31,32].…”

Section: Off Stagementioning

confidence: 99%

“…For ectopic thymoma or orthotopic tumor grown outside the mediastinum, the treatment can be accomplished without total thymectomy [31]. We suggest to look for R0 instead of making a total thymectomy if the tumor is far detached from the thymus gland and to follow the patient up for a supposed enhanced risk of new primary thymic malignancies [31,32].…”

Section: Off Stagementioning

confidence: 99%

Stage-related outcome for thymic epithelial tumours

et al. 2019

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Background: Thymic epithelial tumours (TETs) are characterized by a wide variety of biological behaviors. Radical resection and stage are strong prognostic factors. Aim of this study is to review our Single Center Experience. Methods: One hundred and seventy-seven patients observed in the period from January 2000 to December 2016 were included in the study. Data regarding clinicopathologic features, treatment, and survival were collected. Stagerelated clinical standpoints and therapeutic options were also evaluated. Results: Non-surgical treatment was primarily performed in 15 (8.47%), unresectable disease was intraoperatively found in 12 cases (7.4%). The analysis of 150 patients undergoing curative surgery revealed 70 stage I TET (46.66%), 49 stage II (32.66%), 19 stage III (12.66%), 6 stage IVa (4%) and 6 stage IVb (4%) at the first hospital admission. Histology identified 12 A thymoma (8%), 38 AB (25.33%), 24 B1 (16%), 50 B2 (33.33%), 19 B3 (12.66%) and 7 carcinomas (4.66%). The mean follow up time was 84.14 months (sd = 61.68 months). Disease relapse occurred in 13 patients (8.78%) at a mean period of 78.85 months (sd = 60.87 months) after surgery. Exitus due to thymoma happened in 6 cases (4.05%) after a mean survival of 56.02 months (sd = 25.17 months). The 5-year overall survival rate was 0.94 (95%CI 0.88-0.97) and the 5-year disease-free survival rate was 0.90 (95%CI 0.83-0.94). The 5-year overall survival rates were 96.1% (95% CI, 89.9-98.5%) for the early stages and 87.4% (95% CI, 65.6-95.8%) for the advanced stages (p = 0.670). The 5-year disease-free survival rates resulted being 98.8% (95% CI, 92.3-99.8%) for the early stages and 59.8% (95% CI, 37.8-76.2%) for the advanced stages (p < 0.001). Conclusions: Advanced stage TETs are characterized by higher mortality and recurrence rates. Although technically demanding, surgery, as part of multimodality therapy, could prolong survival. Iterative surgical treatment of recurrences is a viable option for selected patients. Trial registration: The study was approved by the Institutional Review Board of Perugia and Terni University Hospitals [Code T1003] and was retrospectively registered.

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Could thymomectomy be a reasonable option for non-myasthenic thymoma patients?

Cited by 14 publications

References 37 publications

Morphological assessment of thymic carcinoma through imaging: is computed tomography useful in selecting patients for surgery and in predicting incomplete resection?

Morphological assessment of thymic carcinoma through imaging: is computed tomography useful in selecting patients for surgery and in predicting incomplete resection?

Standardized definitions and concepts of radicality during minimally invasive thymoma resection

Stage-related outcome for thymic epithelial tumours

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