Abstract
Simple SummaryThe standard treatment for thymic tumors is radical thymectomy with en bloc resection of the surrounding tissue for early stages, while multimodality therapy has to be considered in the advanced stages. Due to the rarity of nodal metastases in thymic tumors, little attention has been paid to their incidence, pattern and prognostic significance and, consequently, no standard nodal mapping or consensus on lymph node dissection has currently been established. Moreover, no data indicate which subgroup of patients would be appropriate candidates for lymph node dissection D or the extent to which lymph nodes should be harvested. The aim of this review is to collect evidence from the useful literature to help physicians in designing the best surgical procedure when dealing with thymic malignancies and to plan the best multidisciplinary strategy in case of advanced stage thymic tumors.Thymic tumors are the most common primary neoplasms of the anterior mediastinum, although, when compared with the entire thoracic malignancies, they are still rare. Few studies addressed the questions about lymph node involvement pattern in thymic neoplasms, about which subgroup of patients would be appropriate candidates for lymph node dissection or about the extent of lymphadenectomy or which lymph nodes should be harvested. The aim of this review is to collect evidence from the literature to help physicians in designing the best surgical procedure when dealing with thymic malignancies. A literature review was performed through PubMed and Scopus in May 2021 to identify any study published in the last 20 years evaluating the frequency and the extent of lymph node dissection for thymic tumors, its impact on prognosis and on postoperative management. Fifteen studies met the inclusion criteria and were included in this review, with a total of 9452 patients with thymic cancers; lymph node metastases were found in 976 (10.3%) patients in total. The current literature is heterogeneous in the classification and reporting of lymph node metastases in thymic carcinoma, and data are hardly comparable. Surgical treatment should be guided by the few literature-based pieces of evidence and by the experience of the physicians.
Highlights
Thymic tumors are the most common primary neoplasms of the anterior mediastinum, when compared with the entire thoracic malignancies, they are still rare
Five-years survival was strictly dependent on the progression of N factor both in thymomas (95.6% in N0, 61.5% in N1, 20% in N2) and thymic carcinoma (56.0% in N0, 42.1% in N1, 29.3% in N2 and 18.8% in N3) and multivariate analysis showed that lymph node metastases were independent predictors of survival in both groups (p = 0.053 and p = 0.001)
Thymic tumors are the most common primary neoplasms of the anterior mediastinum, and their standard treatment is represented by radical thymectomy with en bloc resection of the surrounding thymic tissue
Summary
Thymic tumors are the most common primary neoplasms of the anterior mediastinum, when compared with the entire thoracic malignancies, they are still rare. The prevalence of lymph nodes involvement has been described as ranging from 1.8 to 5.1% in thymomas and from 20 to 33.5% in thymic carcinomas and NETTs, but these rates could be underestimated because lymphadenectomy is rarely performed by most institutions [3,6,7,8]. Due to their rarity, little attention has been paid to the incidence, the pattern and prognostic significance of lymph node (LN) metastasis in thymic malignancies and, no standard nodal mapping or consensus on lymph node dissection (LND) has been established yet. Comes the question whether to perform lymphadenectomy and how it could impact on prognosis and improve disease control
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