Outcomes of extended surgical resections for locally advanced thymic malignancies: a narrative review

Abstract

Background and Objective: Thymic malignancies represent the most common anterior mediastinal neoplasms, as well as rare and challenging tumors. Surgery is the cornerstone in the treatment of thymic malignancies, although a multidisciplinary approach is mandatory, for both, locally advanced or metastatic disease. In our narrative review, we explored the recent literature to investigate clinical and radiological assessment, multimodality approach and outcomes of locally advanced thymic tumors. More than one-third of patients affected by an anterior mediastinal mass are asymptomatic at diagnosis. In case of locally advanced thymoma, symptoms are related to compression or invasion of adjacent structures, such as the superior vena cava (SVC), innominate veins and pericardium. Paraneoplastic syndromes, such as myasthenia gravis (MG), are related to release of antibodies, hormones and cytokines.Methods: Diagnostic methods must be chosen accurately to avoid unnecessary surgical resections, to define the best strategy of care, and to plan the surgical strategy. Therefore, each case must be evaluated in a multidisciplinary context, where surgery plays an essential role.

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

“…Also according to the literature, the role for MIS in the case of extended surgery for thymic neoplasms is still controversial and remains mainly correlated with anatomical features, abilities of surgeon and multidisciplinary attitude [9]. Soder and co-workers [22] retrospectively analyzed a monocentric 20-year experience in thymic surgery comparing open and robotic approach: They find a significant reduction in PC in the robotic group (6.8% versus 21.1%) despite a significant greater proportion of extended resections in the robotic group after a propensity score match.…”

“…Conversely, in a small retrospective study, Chen [23] compared VATS and open surgery in the treatment of Masaoka stage III thymomas and they found that phrenic nerve and vena cava resection was more likely to be performed by open surgery rather than VATS. Nonetheless, in the vast majority of reported experiences, complex extended resections are performed by open sternotomy, thoracotomy or clamshell incision [3, 9, 21, 24, 25].…”

“…The same applies to thymus surgery, where MIS has gradually become a well‐established alternative approach in clinical practice, for both malignant and benign diseases, even though this approach has not been supported yet by prospective studies [2]. Nevertheless, locally aggressive disease might require extended resections of one or more surrounding organs (e.g., lung, chest wall, pericardium, phrenic nerve) increasing the difficulty of procedures that might require to be performed by open technique according to the extent of the disease and of the experience of the surgeon [4, 9].…”

Thymic Epithelial Tumors: An Evolving Field

“…In this regard, the use of robot-assisted surgical techniques is continuously increasing, given the better surgical field offered and the possibility to articulate the instruments, allowing a precise and adequate dissection. Partial or total sternotomy is, of course, still used, but is reserved for huge masses and advanced cases with invasion of surrounding organs or structures, in particular great vessels [ 104 , 105 ].…”

Diagnostic performance of radiomics model for preoperative risk categorization in thymic epithelial tumors: a systematic review and meta-analysis

“…Thymic epithelial tumors (TETs) are one of the most common primary tumors in the mediastinum, accounting for up to 50% of all anterior mediastinal neoplasms in adults [ 1 , 2 ]. Incidental thymus tumors are almost always asymptomatic and appropriate serum markers are absent, so the clinician’s decision-making on treatment largely depends on imaging findings.…”