Early and mid-term outcomes of trans-sternal and video-assisted thoracoscopic surgery for thymoma

Manoly, Imthiaz; Whistance, Robert N.; Sreekumar, Rahul; Khawaja, Saud; Horton, Joanne M.; Khan, Ali Zamir; Casali, Gianluca; Thorpe, J. A. C.; Amer, Khalid; Woo, E.

doi:10.1093/ejcts/ezu077

Cited by 55 publications

(52 citation statements)

References 23 publications

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“…9 Both unilateral and bilateral videothoracoscopic surgical techniques are gaining in popularity based on the benefits of shorter LOS and relatively fewer surgical complications without compromising therapeutic outcomes when compared with trans-sternal thymectomies. 2 In an attempt to improve on these benefits, use of a robotic-assisted surgical system was implemented for the first time in the resection of a mediastinal surgery controls. 5 Augustin et al 5 demonstrated that robotic-assisted thymectomy had similar LOS (2-5 days) and overall shorter operative times than videothoracoscopic surgery thymectomies reported in the literature.…”

Section: Thymectomymentioning

confidence: 99%

Robotic-Assisted Videothoracoscopic Mediastinal Surgery

2015

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Section: Thymectomymentioning

confidence: 99%

Robotic-Assisted Videothoracoscopic Mediastinal Surgery

2015

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“…Ye et al (41) demonstrated that the oncological outcomes were comparable for TT and OT groups. Manoly et al (42) concluded that the DFS was comparable between the groups. Several reports demonstrated that there was no significant difference in the DFS between the groups (43,49).…”

Section: Surgical Treatmentmentioning

confidence: 96%

Surgical and oncological outcomes of thoracoscopic thymectomy for thymoma

Odaka¹,

Tsukamoto²,

Shibasaki³

et al. 2017

J. Vis. Surg.

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type classification are valuable predictors of the prognosis of thymoma; hence, the optimal treatment for thymoma should be performed according to these two. TT is less invasive, with equivalent oncological outcomes, when compared with the OT. Minimally invasive surgery including TT for stage I-II thymomas is becoming the mainstay of therapy. (16,(20)(21)(22)(23). In our previous study (24), Masaoka stage III-IV thymoma patients experienced more recurrences than those with stage I-II patients. The 5-year disease-free survival (DFS) for stage III-IV thymomas was significantly poorer than those for stage I and II thymoma (47% vs. 97.5% and 94.1%, respectively). Hence, the Masaoka stage was a valuable predictor of the prognosis of thymoma. Keywords Pathologic classificationThe pathologic classification of thymoma has remained controversial for many years (25). The World Health Organization (WHO) has developed the most widely adopted pathologic classification for epithelial tumor of thymus by taking into consideration both histological and morphological features (26). There are two staging systems for epithelial tumor of thymus (27). Most widely used clinical stage was first described by Masaoka et al. in 1981, and it is a clinical staging system describing thymomas in terms of local extension or invasion of the tumor (6). The TNM staging follows the pattern of T for tumor descriptor, N for nodal spread, and M for distance metastasis. In 1999, the WHO Consensus Committee published a histologic typing system for neoplasms of the thymus (28). Thymomas are classified into types A, AB, B1, B2, B3, and C based on the morphology of epithelial cells and ratio of lymphocyteto-epithelial cells. Recently, the WHO Consensus Committee recommended that epithelial tumors of thymus be classified as thymoma, including type A, AB, B1, B2, and B3 thymoma and thymic carcinoma (29). Most of the WHO type A, AB, B1, and B2 thymomas are benign; however, types B3 and C have malignant potential (30). Our study (24) demonstrated that 16 of 140 thymomas patients experienced recurrences. Of those 16 patients, 12 patients had WHO type B3 or C thymomas. Thus, pathological aggressiveness seems to strongly influence recurrence. Several reports have indicated the impact of the WHO type on the decisionmaking during clinical treatments (26). Surgical treatmentMost patients having Masaoka stage I-II thymoma receive surgical treatment. Recently, TT has been attempted as a surgical treatment for thymoma. TT for thymoma consists of extended thymectomy (ET), total thymectomy, subtotal thymectomy (STT), and partial thymectomy according to the classification of the extent of the thymus resected. In this review, a few authors classified thymectomy by total and partial thymectomy, while some authors do not describe the resected extent of thymus clearly. Total thymectomy was defined as the resection of the entire thymus, and ET was defined as the resection with the thymus and surrounding fat tissues together. ET was usually performed in patients who had MG. F...

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“…patients, and on the hypothetical risk that a second primary thymoma may develop in the residual thymus gland (4,7). However, an increasing number of reports over the recent years have shown that thymectomy can be accomplished safely and effectively by VATS both for early-stage thymoma and for MG (8)(9)(10)(11)(12)(13)(14).A recently published propensity-matched study on patients undergoing either trans-sternal or minimally invasive thymectomy for stage I-II thymoma showed overall postoperative complications rates to be lower with VATS thymectomy, and suggested that in fact, the majority of complications in the open group were due the complications of median sternotomy (15).There are no randomized trials that compare minimally invasive and open thymectomy, but VATS thymectomy was compared to the traditional open approach in two recent large meta-analyses (16,17). Both such studies showed significantly reduced postoperative blood loss and blood products requirements, reduced postoperative pain scores, reduced overall complications rates and reduced postoperative hospital stay with VATS thymectomy compared with open thymectomy.…”

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confidence: 99%

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confidence: 99%

VATS thymectomy for early stage thymoma and myasthenia gravis: combined right-sided uniportal and left-sided three-portal approach

et al. 2017

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The traditional approach to thymectomy requires median sternotomy based on the assumption that it is the best means to achieve adequate resection margins, complete removal of the thymus and clearance of the anterior mediastinal fat. However, in recent years, VATS thymectomy has been gaining acceptance as a means to achieve adequate oncologic results and symptomatic improvement of myasthenic symptoms with less impact on the patient. We have adopted a flexible approach based on the location of the tumor and on whether the patient has myasthenia gravis (MG) or not when planning minimally invasive VATS thymectomy. A preferential approach from the left side is chosen for clinical stage I-II thymomas located on the left side or on the midline in patients without MG, and a bilateral approach (uniportal VATS on the right side and three-portal VATS on the left side) for MG patients with or without thymoma in order to achieve complete clearance of the anterior mediastinal fat on both sides. Such techniques are herewith clearly illustrated in hope that surgeons wishing to endeavor in such an effort will be facilitated. patients, and on the hypothetical risk that a second primary thymoma may develop in the residual thymus gland (4,7). However, an increasing number of reports over the recent years have shown that thymectomy can be accomplished safely and effectively by VATS both for early-stage thymoma and for MG (8)(9)(10)(11)(12)(13)(14).A recently published propensity-matched study on patients undergoing either trans-sternal or minimally invasive thymectomy for stage I-II thymoma showed overall postoperative complications rates to be lower with VATS thymectomy, and suggested that in fact, the majority of complications in the open group were due the complications of median sternotomy (15).There are no randomized trials that compare minimally invasive and open thymectomy, but VATS thymectomy was compared to the traditional open approach in two recent large meta-analyses (16,17). Both such studies showed significantly reduced postoperative blood loss and blood products requirements, reduced postoperative pain scores, reduced overall complications rates and reduced postoperative hospital stay with VATS thymectomy compared with open thymectomy. Operating-room time was not significantly different between the two techniques.Most importantly, the probability of achieving microscopically complete resection (i.e., tumor free margins at pathologic examination) and loco-regional recurrence rates were similar with either approach.Over 50% of thymoma patients may suffer from a variety of autoimmune diseases, the most common of which are MG, erythroid aplasia and hypogammaglobinemia. Up to 25% of thymoma patients will have clinically overt MG and an additional 25% of clinically asymptomatic thymoma patients will have circulating anti-acetylcholinesterase receptor (anti-Ach-R) autoantibodies. Conversely, in 5-15% of the patients with MG, preoperative work up eventually demonstrates an unsuspected thymoma (18,19).Thymectomy in M...

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Early and mid-term outcomes of trans-sternal and video-assisted thoracoscopic surgery for thymoma

Abstract: VATS thymectomy for thymoma is feasible, safe and has comparable mid-term oncological outcomes to trans-sternal thymectomy. Future research is required to evaluate long-term oncological outcomes of VATS thymectomy for thymoma in national registries and randomized, controlled trials.

Cited by 55 publications

References 23 publications

Robotic-Assisted Videothoracoscopic Mediastinal Surgery

Robotic-Assisted Videothoracoscopic Mediastinal Surgery

Surgical and oncological outcomes of thoracoscopic thymectomy for thymoma

VATS thymectomy for early stage thymoma and myasthenia gravis: combined right-sided uniportal and left-sided three-portal approach

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