Standard Terms, Definitions, and Policies for Minimally Invasive Resection of Thymoma

Abstract

H aving a common language including well-defined terms and adherence to certain policies and procedures in the management of patients with thymic malignancies is necessary to facilitate progress. This is especially true for minimally invasive resections. Different technical approaches have been used, 1,2 and a careful examination of results is needed to understand the impact of the minimally invasive approach itself, as opposed to other factors. For example, during an open approach, most surgeons perform a complete en bloc resection of the tumor and a complete thymectomy with removal of the upper cervical poles and the surrounding mediastinal fat 3 ; whether this is done during minimally invasive resections is hard to decipher at present. This article identifies key aspects that should be reported, common definitions that should be adopted and proposes certain standard policies that should be adhered to when performing a minimally invasive resection of a thymic malignancy. These definitions and policies do not apply to biopsies. These policies are not meant to stifle innovation; on the contrary, they should facilitate progress by providing a framework, so that experiences and outcomes can be compared and analyzed more clearly. These standards have been adopted by members of the International Thymic Malignancy Interest Group (ITMIG), which is a worldwide collaborative organization of individuals interested in mediastinal tumors.

Technique of the Transcervical-Subxiphoid-Videothoracoscopic Maximal Thymectomy

“…Minimally invasive techniques of thymectomy recently became accepted operative techniques in early-stage thymomas (18). The experience gained by our team and other surgeons supports this policy (19).…”

Minimally invasive thymectomy for locally advanced recurrent thymoma

“…This would help minimize surgical trauma, reduce incisional pain, and facilitate early recovery. Although long-term outcome still awaits proof from large sample results, it does no harm at least to try VATS exploration first, as long as oncological principles are observed (8). These should include total thymectomy together with the tumor, en-bloc resection of the lesion and invaded surrounding structures, and a notouch technique to prevent iatrogenic tumor spread so as to minimize the risk of local recurrence.…”

Video-assisted and minimally-invasive open chest surgery for the treatment of mediastinal tumors and masses

“…This has certainly been the experience of the senior author of this review. More recent data from the SEER database (20) have shown, however, that as much as 15% of patients may have lymph node involvement and that all patients undergoing thymectomy for TETs should have routine sampling or even dissection of lymph nodes, especially of the nodes located in the anterior mediastinum (17,20).…”