Early stage thymoma: is VATS the new standard of care?

Batırel, Hasan Fevzi

doi:10.21037/jtd.2016.05.35

Cited by 5 publications

(4 citation statements)

References 6 publications

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“…But there have been numerous reports and case series which have shown good outcomes when resecting large anterior mediastinal masses using minimally invasive approaches (3,4). In experienced centers, these large tumors can be resected using minimally invasive approaches with no differences in rates of R0 resection, perioperative complication rate (5,6) and with a low conversion rate (7). Surgeons should individualize each case and use their comfort levels with minimally invasive techniques when deciding whether a tumor can be completely resected by VATS or RATS.…”

Section: Minimally Invasive Approachesmentioning

confidence: 99%

Contemporary treatment for thymic malignancies: what’s the bottom line?

2018

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Section: Minimally Invasive Approachesmentioning

confidence: 99%

Contemporary treatment for thymic malignancies: what’s the bottom line?

2018

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“…Recently, minimally invasive techniques, including thoracoscopic and robot-assisted thoracic surgery, have become the standard of care for early-stage thymic tumors ( 4 – 6 ). However, the appropriate surgical approach remains controversial due to the recommendation to remove all thymus glands, both encapsulated and extracapsular tissues, during surgery, resulting in a better outcome for patients with MG. Several studies have shown that minimally invasive thymectomy can reduce intraoperative blood loss, postoperative pain, and postoperative complications ( 7 – 9 ). However, the neurological outcomes of MG after minimally invasive thymectomy are debatable.…”

Section: Introductionmentioning

confidence: 99%

Neurological outcomes of extended thymectomy for thymomatous myasthenia gravis: Subxiphoid vs. trans-sternal approaches

et al. 2022

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BackgroundThe subxiphoid approach has been widely used recently. However, there is little data focusing on neurological outcomes in patients with thymomatous myasthenia gravis (MG) who underwent subxiphoid thoracoscopic thymectomy. The purpose of this study was to compare the neurological outcomes of patients with thymomatous MG who underwent extended thymectomy with a subxiphoid or transthoracic approach 1 year postoperatively.MethodsThe records of patients with Masaoka stage I and II thymomas who underwent extended thymectomy from January 2019 to December 2020 with tumor size less than 5 cm and thymomatous MG were retrospectively reviewed and evaluated. Neurological outcomes were measured by a quantitative myasthenia gravis score (QMGS), with a 2.3-point reduction in QMGS associated with improvement in clinical MG status. The clinical efficacy and variables affecting the outcomes were assessed using the Kaplan–Meier method and Cox proportional hazard regression analysis.ResultsA total of 89 patients were included in the analysis, of which 44 had a subxiphoid approach and 45 had a trans-sternal approach. Mean QMGS decreased from 12 at initial diagnosis to 8.7 preoperatively and 5.6 at 12 months postoperatively in the subxiphoid group and from 12.1 to 8.9 to 6.0 in the transthoracic group. Thirteen patients (28.9%) who underwent the trans-sternal approach and 10 (22.7%) who underwent the subxiphoid approach did not have an improved clinical status compared with their preoperative status. The median time to clinical improvement was 3 months (95% CI, 2.15–3.85) for the subxiphoid approach and 6 months (95% CI, 5.54–6.46) for the trans-sternal approach. Univariate results showed that the subxiphoid approach was associated with a faster improvement in clinical status (HR = 1.701, 95% CI, 1.044–2.773, P < 0.05), and age ≦48 was associated with a faster improvement in clinical status (HR = 1.709, 95% CI, 1.044–2.799, P < 0.05). The multivariate model including age ≦48 (HR = 1.837, 95% CI, 1.093–3.086, P = 0.022) and the subxiphoid approach (HR = 1.892, 95% CI, 1.127–3.177, P = 0.016) was significantly associated with a faster improvement in clinical status.ConclusionsIn patients with Masaoka stage I and II thymoma who underwent thymectomy, with tumor size less than 5 cm and thymomatous MG, age ≦48 years and the subxiphoid approach were associated with a rapid improvement in clinical status.

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“…In addition, trauma to the thoracic diaphragm and movement after traditional open-chest surgery could easily lead to postoperative atelectasis, pneumonia, respiratory dysfunction, and other severe complications, causing patients to recover slowly, extend their hospital stays and incur increased costs. Although video-assisted thoracoscopic surgery is increasingly used for mediastinal tumor resection and has the advantages of minor trauma and a clear surgical field, the surgery is complex, difficult, and highly technical to perform [9–12]. Therefore, the application of surgical resection for thymoma treatment is still controversial.…”

Section: Introductionmentioning

confidence: 99%

An exploratory study of CT-guided percutaneous radiofrequency ablation for stage I thymoma

et al. 2019

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BackgroundThymoma is a rare tumor that originates from thymic epithelial cells and is usually associated with myasthenia gravis. Radiofrequency ablation (RFA) is a minimally invasive and curative treatment for other tumors, but RFA has not been used for the early treatment of thymoma.MethodsThe current study included 13 patients with stage I thymoma who were not candidates for surgical resection or video-assisted thoracoscopic surgery (VATS). All patients underwent first-line CT-guided percutaneous RFA. The feasibility and therapeutic effects of the intervention were thoroughly documented.Results All tumors were completely ablated (13 / 13, 100%). During follow-up (median 80.5 months, range, 64.6–116.9 months), only 1 of the 13 patients had recurrence of thymoma (1 / 13, 7.7%) at 35.5 months after the initial ablation. There were no surgery-related deaths after RFA treatment. The most common complications were fever (13 / 13, 100%) and pain (13 / 13, 100%). There was only one patient who occurred severe puncture-related bleeding during the procedure that needed blood transfusion and intravascular embolization of the punctured-injured vessel.ConclusionCT-guided percutaneous RFA for treatment of stage I thymoma is associated with minor trauma, few complications and good treatment outcomes.

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Early stage thymoma: is VATS the new standard of care?

Cited by 5 publications

References 6 publications

Contemporary treatment for thymic malignancies: what’s the bottom line?

Contemporary treatment for thymic malignancies: what’s the bottom line?

Neurological outcomes of extended thymectomy for thymomatous myasthenia gravis: Subxiphoid vs. trans-sternal approaches

An exploratory study of CT-guided percutaneous radiofrequency ablation for stage I thymoma

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