MS03.03 Minimally Invasive Surgical Strategies and Considerations for Small Anterior Mediastinal Lesions

Abstract

Thymomas are the most common anterior mediastinal masses. These are slow growing relatively indolent tumors that are often curable with surgical resection. Thymomas are often detected in asymptomatic patients who had a computed tomography of the chest for other reasons. Until recently, the surgical standard of care for curative surgery was resection of the thymus en-bloc with the mass through an open sternotomy. Advances in video surgery have allowed resection of the thymus and the anterior mediastinal masses through small incisions. Currently, there are multiple minimally invasive approaches to the anterior mediastinum, including thoracoscopy though the chest wall, thoracoscopy through a subxiphoid incision, and robotic assisted thoracoscopy. Although data comparing the techniques is sparse, there is no reason to believe that one has oncologic or survival advantages over the other. Data comparing minimally invasive approaches with open approaches have shown better short-term outcomes such as postoperative complications and blood loss, and similar long-term survival. Several authors have questioned the need for a complete thymectomy in patients with small anterior mediastinal lesions, hence the term thymomectomy. Thymomectomy involves the removal of the thymoma only, with margins around it, but without a formal complete thymectomy. Data comparing complete thymectomy with thymomectomy is sketchy and likely unreliable. Another area of intense investigation is the role of nodal dissection or sampling in the surgical management of thymomas. Data from multiinstitutional database suggests that the incidence of nodal metastases is higher than previously thought. Although data is lacking, removal of enlarged nodes, or sampling of nodes in the anterior mediastinum is likely indicated. In summary, small anterior mediastinal masses can be removed using minimally invasive techniques. The need for complete thymectomy, and nodal sampling are areas of investigation. Until more data is available, complete thymectomy with nodal sampling appears prudent. THYMOMA, minimally invasive surgery, Robotic Surgery