Abstract
Background:For stage III or IVa thymic tumours, a multimodality approach is recommended. The role of surgery is to achieve complete resection.Aim:To present the outcomes of patients undergoing surgery for stage III or IVa thymoma.Methods:Retrospective review of patients undergoing open surgery for stage III or IVa thymoma between 2016 and 2020 at a single centre was performed. Preoperative imaging, treatment plan, surgical approach, and postoperative outcomes were analyzed.Results:Forty-seven patients underwent surgery for thymoma. Patients with clinical stage I/II thymoma or minimally invasive thymectomy were excluded. Thirteen patients with clinical stage III or IVa were included. Median sternotomy approach was used in four patients, of which one was redo sternotomy; a hemi-clamshell in four; and a combination of approaches in the remaining five patients. There was no postoperative mortality. Four patients had postoperative complications. Complete resection was achieved in all but two patients. At a median follow-up of 17.9 months, all patients were alive with no evidence of recurrence except one who died 4 months after surgery from coronavirus disease 2019 (COVID-19) pneumonia.Conclusions:Surgery for stage III and IVa thymoma is safe and can be achieved with complete macroscopic resection. To obtain adequate exposure of all structures involved in the tumour, combined surgical approaches can be used with no increased morbidity. The majority of patients, even after extrapleural pneumonectomy, did not receive adjuvant radiotherapy and had no evidence of local relapse.
Highlights
IntroductionUp to 40% of patients can present with locally advanced stage III or IVa thymoma.[1,2] Surgery is the main treatment for early-stage thymic tumors
Thymic tumors are rare and thymoma is the most common histology
Our aim was to assess the outcomes of surgery in stage III and IVa thymoma and attempt to evaluate the best surgical approach and methods of reconstruction of involved structures in order to achieve a complete macroscopic resection, according to the extent of disease based on preoperative imaging and intraoperative findings
Summary
Up to 40% of patients can present with locally advanced stage III or IVa thymoma.[1,2] Surgery is the main treatment for early-stage thymic tumors. In patients with stage III or IV athymic tumors, a multimodality approach is recommended, with the aim of surgery being to achieve a complete macroscopic resection (R0),[1] usually after neoadjuvant chemotherapy. Shapiro and Korst[1] reviewed methods of surgical resection for patients with stage IVa thymic tumors and highlighted how the surgical approach is chosen based on disease extension and surgeon experience. Aim: To present the outcomes of patients undergoing surgery for stage III or IVa thymoma. Conclusions: Surgery for stage III and IVa thymoma is safe and can be achieved with complete macroscopic resection. The majority of patients, even after extrapleural pneumonectomy, did not receive adjuvant radiotherapy and had no evidence of local relapse
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