Iterative Surgical Treatment for Repeated Recurrences After Complete Resection of Thymic Tumors

Fiorelli, Alfonso; D’Andrilli, Antonio; Vanni, Camilla; Cascone, Roberto; Anile, Marco; Diso, Daniele; Tassi, Valentina; Vannucci, Jacopo; Serra, Nicola; Puma, Francesco; Rendina, Erino Angelo; Venuta, Federico; Santini, Mario

doi:10.1016/j.athoracsur.2016.08.086

Cited by 23 publications

(32 citation statements)

References 18 publications

(77 reference statements)

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“…Finally, 9 studies met all inclusion criteria and were selected for meta-analysis [2,4,5,[11][12][13][14][15][16]] (Figure 1). Of note, two studies were from our institution [2,15].…”

Section: Literature Resultsmentioning

confidence: 99%

Which Is the Best Treatment in Recurrent Thymoma? A Systematic Review and Meta-Analysis

Chiappetta

Grossi

Sperduti

et al. 2021

Cancers

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Background: Optimal recurrent thymoma management remains arguable because of limited patient numbers, and relatively late and variable recurrence patterns. Given the absence of high-quality evidence and relatively small study cohorts, we performed a quantitative meta-analysis to determine the outcome of surgical and non-surgical approaches assessing the five-year overall survival (5y overall survival (OS)) in patients with recurrent thymoma. Methods: We performed a comprehensive literature search and analysis according to PRISMA guidelines of studies published from 1 January 1980 until 18 June 2020 from PubMed/MEDLINE, EMBASE, and Scopus. We included studies with the cohorts’ superior to 30 patients describing recurrent thymoma treatment, comparing surgical and non-surgical approaches reporting survival data. Results: Literature search revealed 3017 articles. Nine studies met all inclusion criteria and were selected for the meta-analysis. The recurrences were local/regional in 73–98% of cases and multiple in 49–72%. After treatment, 5y OS ranged from 48–77% and 10y OS from 37–51%. The quantitative meta-analysis showed a better outcome comparing surgical vs other treatments. Two studies showed statistically significant risk differences in the 5y OS favoring complete resection. After pooling results of seven studies using the random model, the combined 5y OS risk difference was 0.39, with lower and upper limits of 0.16 and 0.62, respectively (p = 0.001), and a moderate heterogeneity among studies (p = 0.098, I2 = 43.9%). Definitive conclusions could not be drawn regarding the prognostic impact of myasthenia gravis, histology, and patterns of relapse reported in literature. Conclusions: Surgical treatment after thymoma recurrence is associated with a significant better 5y OS; therefore, surgical resection should be preferred in all technically feasible cases.

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“…Finally, 9 studies met all inclusion criteria and were selected for meta-analysis [2,4,5,[11][12][13][14][15][16]] (Figure 1). Of note, two studies were from our institution [2,15].…”

Section: Literature Resultsmentioning

confidence: 99%

Which Is the Best Treatment in Recurrent Thymoma? A Systematic Review and Meta-Analysis

Chiappetta

Grossi

Sperduti

et al. 2021

Cancers

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“…(I) It is widely known that the risk of recurrence is correlated to Masaoka stage, tumor size, WHO histological classification and completeness of resection (3,(18)(19)(20)27). Few studies have investigated on how the extent of resection on the healthy thymus may affect the prognosis.…”

Section: Discussionmentioning

confidence: 99%

“…Recurrences were classified as local, whenever they occurred in the anterior mediastinum or tissues immediately contiguous to the resected thymoma; regional when they were intrathoracic (pleural or pericardial implants) not contiguous to resected thymoma and distant when they had haematogenous or lymphogenous spread (24). The treatment of choice for recurrence was iterative surgery, often followed by adjuvant therapy (19). Whenever surgery was not possible, due to the tumour site, patient age or comorbidities, patients underwent chemoirradiation.…”

Section: Follow-upmentioning

confidence: 99%

“…The rationale for extended thymectomy in non-myasthenic patients is also weakened by the extremely rare finding of multicentric thymomas within the resected gland (16,17). A complete resection of thymoma, as well as Masaoka stage, World Health Organization (WHO) histological type and tumour size, is a strong prognostic factor for survival (18)(19)(20). Currently, only few studies have investigated the extension of the resection in the healthy thymus (12)(13)(14)(15).…”

Section: Introductionmentioning

confidence: 99%

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

et al. 2017

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“…Once decided to submit the patient to surgery for stage IV thymoma, diagnostic and staging information must satisfy technical conditions for a possible macroscopically complete resection; if it is absolutely not achievable, any surgical plan should be abandoned [25,28]. Redo-surgery is not self-limiting and cases of indolent disease can develop multiple metachronous metastasis that can undergo surgery time by time [16,29].…”

Section: Stage IVmentioning

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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Iterative Surgical Treatment for Repeated Recurrences After Complete Resection of Thymic Tumors

Abstract: Complete resection is a viable treatment option for selected patients with recurrent thymomas. In cases of technically resectable repeated recurrences, repeated operations should be considered.

Cited by 23 publications

References 18 publications

Which Is the Best Treatment in Recurrent Thymoma? A Systematic Review and Meta-Analysis

Which Is the Best Treatment in Recurrent Thymoma? A Systematic Review and Meta-Analysis

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

Stage-related outcome for thymic epithelial tumours

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