Oncological outcomes of thoracoscopic thymectomy for the treatment of stages I–III thymomas

Abstract

Thoracoscopic thymectomy for Masaoka stages I and II thymomas presented acceptable oncological outcomes. Further investigation in a large series with longer follow-up is required. Masaoka stage III thymoma requires careful consideration of the approaches, including median sternotomy.

Is a diagnostic video-assisted thoracoscopic thymectomy an acceptable first-line approach to the suspicious anterior mediastinal mass?

“…have reported their single centre experience with 62 VAT thymectomy patients for thymoma with acceptable oncological outcomes for Stage I and Stage II thymoma (5-year disease-free survival of 100% and 96.1%, respectively). [ 17 ] Maggi et al . have reported no difference in recurrence rates between VAT and sternotomy approach in a single centre study of myasthenia associated thymoma with follow-up of 20 years.…”

Single-Centre 20-Year Experience with Surgical Treatment of Thymic Tumours

“…However, due to the indolent growth pattern of thymic malignancies, long-term follow-up data are needed to evaluate the safety of these procedures (completeness of resection, avoidance of pleural seeding etc.) (2,3,5,(15)(16)(17)(18). Out of 124 surgical patients, only 4 were operated using a minimally invasive procedure (2 through VATS in another centre, both referred with a local recurrence ; and 2 with transcervical resections for a hyperplastic thymus showing a small thymoma on final histopathology).…”

Bilateral Video-Assisted Thoracoscopic Thymectomy for Masaoka Stage IIIA Thymomas

“…1,3,9 Although large thymomas can also be resected by unilateral VATS, there is a greater likelihood of a need for conversion, because of the technical difficulties and the possibility of oncological compromise through breaching of the tumor capsule. 6 However, following the accumulation of experience and modifications to the technique, certain invasive tumors detected at the time of surgery can be safely resected by VATS without resorting to sternotomy. 15 In our bilateral VATS thymectomy approach, we have found several points that we feel enhance the surgical method, thus allowing for a safe procedure.…”

“…4,5 However, at present, the role of VATS in the management of thymomas is limited to small, well-encapsulated tumors (Masaoka stage I and II). 3,6 There is no clinical evidence that full sternotomy is the best surgical approach for larger invasive thymomas; therefore, they are generally not resected by unilateral VATS because of oncological concerns regarding the possible breaching of the tumor capsule, with the risk of tumor seeding, the possibility of incomplete resection, and technical difficulties entailing a risk of hemorrhage. 4,7 In recent years, bilateral procedures have been reported for thoracodorsal sympathectomy, splanchnicectomy, and the resection of pulmonary metastases.…”