Early Postoperative Results after Thymectomy for Thymic Cancer: A Single‐Institution Experience

Abstract

Background Surgery for thymic cancers is considered the key of curative treatment. Preoperative patients’ characteristics and intraoperative features might influence postoperative outcome. We aim to verify short-term outcomes and possible risk factors for complications after thymectomy. Methods We retrospectively investigated patients undergoing surgery for thymoma or thymic carcinoma in the period between January 1, 2008, and December 31, 2021, in our department. Preoperative features, surgical technique (open, bilateral VATS, RATS), intraoperative characteristics and incidence of postoperative complications (PC) were analyzed. Results We included in the study 138 patients. Open surgery was performed in 76 patients (55.1%), in 36 VATS (26.1%) and in 26 RATS (36.1%). Resection of one or more adjacent organs due to neoplastic infiltration was required in 25 patients. PC appeared in 25 patients (52% Clavien–Dindo grade I, 12% grade IVa). Open surgery had a higher incidence of PC (p < 0.001), longer postoperative in-hospital stay (p = 0.045) and larger neoplasm (p = 0.006). PC were significant related to pulmonary resection (p = 0.006), phrenic nerve resection (p = 0.029), resection of more than one organ (p = 0.009) and open surgery (p = 0.001), but only extended surgery of more organs was confirmed as independent prognostic factor for PC (p = 0.0013). Patients with preoperative myasthenia symptoms have a trend toward stage IVa complications (p = 0.065). No differences were observed between outcomes of VATS and RATS. Conclusions Extended resections are related to a higher incidence of PC, while VATS and RATS guarantee a lower incidence of PC and shorter postoperative stay even in patients that require extended resections. Symptomatic myasthenia patients might have a higher risk toward more severe complications.

Perspectives on surgical treatment for thymic epithelial tumors: a narrative review

“…VATS or RATS may be selected in cases of pericardial invasion or pleural dissemination; however, if SVC or aortic invasion is present, artificial blood vessel replacement or angioplasty is required, and open-heart surgery is indicated. However, open-heart surgery is associated with a high incidence of postoperative complications and prolonged hospital stay ( 53 ).…”

Stage III–IV thymic squamous cell carcinoma in complete pathological remission achieved with thymic cancer resection after immunotherapy combined with chemotherapeutic conversion therapy: a report of two cases from real-world data

“…Based on the relative proportion of epithelial cells to lymphocytes in thymic tumors, thymomas are classified by the World Health Organization (WHO) into low grade thymomas (types A and AB), high-grade thymomas (types B1, B2 and B3) and thymic carcinomas (type C) ( 2 ). In the past, malignant thymoma and thymic carcinoma were managed in a similar manner, with surgical resection being advocated as the primary treatment modality ( 3 - 5 ). However, a considerable number of patients presents with tumor infiltration into vital structures, such as the pericardium, innominate vein, and superior vena cava, rendering complete resection through direct surgery challenging.…”