Standardized definitions and concepts of radicality during minimally invasive thymoma resection

Abstract

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.

Robotic Thymectomy for Thymomas: A Retrospective Follow-up Study in the Netherlands

“…In accordance with the guidelines of the International Thymic Malignancy Interest Group, the thymomas were resected using the no-touch and en bloc strategies. 7,9 A small pleural drainage catheter was introduced through a separate stab incision. The procedure time was defined as the time from the first incision until the closure of the skin.…”

“…Achieving a thymectomy with free margins is the most important prognostic factor for survival of patients with a thymoma. 7 The aim of this study was to investigate the long-term oncologic, surgical, and neurologic outcomes of all patients who underwent RATS for a thymoma at MUMCþ.…”

Lymph Nodes Involvement and Lymphadenectomy in Thymic Tumors: Tentative Answers for Unsolved Questions

“…Current ITMIG guidelines suggest two surgical procedures for patients with thymic tumors with or without MG, respectively: extended thymectomy including the en bloc removal of the contiguous right and left mediastinal pleura, mediastinal and pericardiophrenic fatty tissues and dissection of aorta-pulmonary window in addition to complete thymectomy or complete thymectomy including the en bloc removal of the upper cervical poles and the surrounding mediastinal fat [33][34][35]. In all cases, complete resection (R0) of thymoma, thymic carcinoma and thymic neuroendocrine tumors is the most important aspect of treatment and the best independent prognostic factor.…”