Does surgical debulking for advanced stages of thymoma improve survival?

Abstract

A best evidence topic in cardiothoracic surgery was written according to a structured protocol. The question addressed was 'Does surgical debulking for advanced stages of thymoma improve survival?' Altogether, only 17 papers were found using the reported search, of which only 10 represented the best evidence to answer the clinical question. The authors, journal, date and country of publication, patient group studied, study type, relevant outcomes and results of these papers are tabulated; these studies have mainly reported the survival and recurrence rates after total vs subtotal resection of thymic tumours in patients receiving or not receiving adjuvant chemoradiotherapy. These studies confirmed that complete resection is the best prognostic factor in thymomas. With regard to subtotal tumour resection/debulking, we did not find any randomized controlled trials. The evidence on this topic is scarce and these 10 reported were retrospective reviews of the operative, histology and survival data of patients with thymoma who had subtotal vs partial resection for advanced stages of thymoma. Although debulking surgery for thymoma had positively affected survival, in six studies, the difference failed to reach statistical significance. Three of the studies, on the other hand, showed a higher survival rate in thymomas in which maximum debulking was performed and the treatment was followed by high-dose irradiation. None of these studies showed any benefit in debulking surgery for thymic carcinoma. Besides histology and tumour cell-type, other factors influencing survival included the tumour stage and the presence of symptoms such as myasthenia gravis as a warning sign at an early stage. Current evidence in the literature on the survival after debulking surgery for thymoma is contradictory, and most of the studies do not show any survival benefit after debulking for thymoma. However, debulking surgery minimizes the tumour size and area for irradiation postoperatively, hence it can result in less damage to the adjacent tissue during radiotherapy and may be considered for patients in advanced stages of thymoma in whom extensive radiotherapy will be required. In these cases, however, the risks of surgery followed by radiotherapy or radiotherapy alone should carefully be assessed prior to the initiation of treatment.

Multimodality therapy for locally advanced thymomas: A propensity score–matched cohort study from the European Society of Thoracic Surgeons Database

“…This issue is of particular relevance when considering that an incomplete resection or debulking procedure could not improve survival relative to biopsy alone, leading to increased recurrence rates and poorer prognosis. 16 In this context, the administration of multimodality therapies has gained growing interest among physicians through the years because of the welldocumented chemoresponsiveness and radioresponsiveness of TTs. With respect to the administration of IT, pioneering experiences were first published in the 1980s by Giaccone and colleagues, 17 and until now few studies and clinical trials on neoadjuvant therapy have been reported in the literature.…”

Risk Factors and Outcomes in Cats with Acquired Myasthenia Gravis (2001–2012)

“…On the basis of the relatively common association of MG and thymoma as shown in our study, we recommend AChR antibody testing on all cats with confirmed or suspected thymoma. This recommendation is standard in human medicine 23, 24…”

Multimodality treatment for advanced thymic carcinoma: outcomes of induction therapy followed by surgical resection in 16 cases at a single institution

“…In patients with tumors that appear to be invasive to the great vessels or metastasis to the lymph nodes, a biopsy should be performed prior to the treatment to decide the strategy. We consider that surgical debulking is acceptable for an invasive thymoma, because of the potential for favorable outcome [15]. Thus, all of the patients in the present study had an initial biopsy, which confirmed thymic carcinoma.…”