Clinical Experience with Thymic Cystectomy: A Single-Institution Study of 117 Cases from 2013 to 2019

Abstract

Background The aim of this study was to summarize the clinical experience of thymic cysts treatment from a single center. Material/Methods Clinical data, imaging, pathological results, and follow-up results of thymic cyst patients who underwent surgery from January 2013 to September 2019 were retrospectively reviewed. Results A total of 117 patients were enrolled, including 76 asymptomatic patients and 41 symptomatic patients. The average diameter of thymic cysts, the cysts in asymptomatic patients, and those in symptomatic patients were 31.93±19.92 mm, 29.28±17.97 mm, and 36.85±22.50 mm, respectively. The number of cysts ranged from 1 to 3 cm, 3 to 6 cm, and >6 cm in 73 cases (62.4%), 32 cases (27.3%), and 12 cases (10.3%), respectively. There was no correlation between the size of thymic cysts and the presence or absence of symptoms. Only 20 cases (17.1%) were correctly diagnosed as thymic cysts before surgery. There were 67 patients (57.3%) who underwent video-assisted thoracic surgery (VATS) and 50 cases (42.7%) underwent open surgery. Cystectomy was performed in 93 cases (79.5%) and 24 cases (20.5%) underwent simultaneous resection of thymic cysts and other thoracic tumors. Compared with the thoracotomy group, the VATS group had shorter hospital stay and chest tube indwelling time. No serious complications occurred after surgery. The median follow-up time was 45.0 months (range 4.0–84.0 months) and there was no recurrence. Conclusions Attention should be paid to the accuracy of preoperative diagnosis of thymic cysts and the reduction of asymptomatic thymic cystectomy. For patients who have both thymic cysts and other thoracic tumors, simultaneous surgery is safe and feasible.

Surgical indications for mediastinal cysts—a narrative review

“…When compared, average thymic cyst diameter did not vastly differ between symptomatic (36.85±22.50 mm) and asymptomatic patients (29.28±17.97 mm). In the same study, the majority of cysts found incidentally were smaller than 3 cm, and the patients were asymptomatic ( 4 ). Despite the limitations of a retrospective study, this study offers valuable information for thoracic surgeons related to the size of the cysts, the symptoms at the time of diagnosis, and relevance of both as criteria for resection.…”

“…The size criteria for resection of thymic cysts has not been established. Larger cysts have a higher probability of producing symptoms; however, when a cut off of 3 cm was used, the size alone did not directly correlate with the presence of symptoms or their final pathology ( 4 ). In their single-center institution retrospective review of 117 cases of benign thymic cysts, Wang et al found that 76 were asymptomatic while 41 were symptomatic.…”