Abstract
Simple SummaryA complete resection of thymic tumors is known to be the most important prognostic factor, but it is often difficult to perform, especially in advanced stages. In this study, patients with advanced thymic tumors who underwent radical resection were examined retrospectively. The primary endpoint was defined as the postoperative resection status. Secondary endpoints included postoperative morbidity, mortality, and survival. In tumor stages III a microscopic complete resection was achieved in 53.3% of patients. In stages IV a macroscopic complete resection was documented in 76.7% of patients. Surgical revision was necessary in 17.8% of patients. In-hospital mortality was 2.7%. The 5-year survival rate of all patients was 61.3%. In particular, median survival after macroscopic incomplete resection was significantly short. Advanced thymic tumors can be resected with an acceptable risk of complications and low mortality. In stage III as well as in stage IV the promising survival rates are dependent on the resection-status.A complete resection of thymic tumors is known to be the most important prognostic factor, but it is often difficult to perform, especially in advanced stages. In this study, 73 patients with advanced thymic tumors of UICC stages III and IV who underwent radical resection were examined retrospectively. The primary endpoint was defined as the postoperative resection status. Secondary endpoints included postoperative morbidity, mortality, recurrence/progression-free, and overall survival. In total, 31.5% of patients were assigned to stage IIIa, 9.6% to stage IIIb, 47.9% to stage IVa, and 11% to stage IVb. In stages III a R0 resection was achieved in 53.3% of patients. In stages IV a R0/R1 resection was documented in 76.7% of patients. Surgical revision was necessary in 17.8% of patients. In-hospital mortality was 2.7%. Median recurrence/progression-free interval was 43 months (p = 0.19) with an overall survival of 79 months. The 5-year survival rate was 61.3%, respectively. Median survival after R2 resection was 25 months, significantly shorter than after R0 or R1 resection (115 months; p = 0.004). Advanced thymic tumors can be resected with an acceptable risk of complications and low mortality. In stage III as well as in stage IV the promising survival rates are dependent on the resection-status.
Highlights
Thymic tumors are limited to the thymus or its surrounding tissue and patients have an excellent prognosis after complete surgical resection [1,2]
This retrospective, single-center study included all patients who received radical surgical resection of an advanced thymic tumor according to UICC stages III and IV from
The comparison with the 5-year survival rate of 61.8% determined in this study indicates that patients in this stage may show a better survival under adequate therapy than those in lower tumor stages
Summary
Thymic tumors are limited to the thymus or its surrounding tissue and patients have an excellent prognosis after complete surgical resection [1,2]. Tumors of UICC (Union internationale contre le cancer) stage III are characterized by invasion of neighboring structures such as lung, major vessels, phrenic, or vagus nerve [1]. It is further divided into stage IIIa—and (still) resectable—tumors and non-resectable stage IIIb tumors [8]. Stage IVa thymic tumors are essentially defined by a pleural dissemination, which has the most relevant effect on therapy [9] In these patients a pleurectomy/decoration (P/D) of the lung should be performed in addition to the mediastinal tumor resection (unless patients present with an isolated pleural recurrence) which sometimes requires a two-step surgery [3,6]. Positive lymph nodes detected in the histological investigation indicate a stage IVa (N1: anterior region) or IVb (N2: deep region) disease, their prognostic significance remains still under discussion [1,10,11,12]
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