Surgical and oncological outcomes of thoracoscopic thymectomy for thymoma

Abstract

type classification are valuable predictors of the prognosis of thymoma; hence, the optimal treatment for thymoma should be performed according to these two. TT is less invasive, with equivalent oncological outcomes, when compared with the OT. Minimally invasive surgery including TT for stage I-II thymomas is becoming the mainstay of therapy. (16,(20)(21)(22)(23). In our previous study (24), Masaoka stage III-IV thymoma patients experienced more recurrences than those with stage I-II patients. The 5-year disease-free survival (DFS) for stage III-IV thymomas was significantly poorer than those for stage I and II thymoma (47% vs. 97.5% and 94.1%, respectively). Hence, the Masaoka stage was a valuable predictor of the prognosis of thymoma. Keywords Pathologic classificationThe pathologic classification of thymoma has remained controversial for many years (25). The World Health Organization (WHO) has developed the most widely adopted pathologic classification for epithelial tumor of thymus by taking into consideration both histological and morphological features (26). There are two staging systems for epithelial tumor of thymus (27). Most widely used clinical stage was first described by Masaoka et al. in 1981, and it is a clinical staging system describing thymomas in terms of local extension or invasion of the tumor (6). The TNM staging follows the pattern of T for tumor descriptor, N for nodal spread, and M for distance metastasis. In 1999, the WHO Consensus Committee published a histologic typing system for neoplasms of the thymus (28). Thymomas are classified into types A, AB, B1, B2, B3, and C based on the morphology of epithelial cells and ratio of lymphocyteto-epithelial cells. Recently, the WHO Consensus Committee recommended that epithelial tumors of thymus be classified as thymoma, including type A, AB, B1, B2, and B3 thymoma and thymic carcinoma (29). Most of the WHO type A, AB, B1, and B2 thymomas are benign; however, types B3 and C have malignant potential (30). Our study (24) demonstrated that 16 of 140 thymomas patients experienced recurrences. Of those 16 patients, 12 patients had WHO type B3 or C thymomas. Thus, pathological aggressiveness seems to strongly influence recurrence. Several reports have indicated the impact of the WHO type on the decisionmaking during clinical treatments (26). Surgical treatmentMost patients having Masaoka stage I-II thymoma receive surgical treatment. Recently, TT has been attempted as a surgical treatment for thymoma. TT for thymoma consists of extended thymectomy (ET), total thymectomy, subtotal thymectomy (STT), and partial thymectomy according to the classification of the extent of the thymus resected. In this review, a few authors classified thymectomy by total and partial thymectomy, while some authors do not describe the resected extent of thymus clearly. Total thymectomy was defined as the resection of the entire thymus, and ET was defined as the resection with the thymus and surrounding fat tissues together. ET was usually performed in patients who had MG. F...

Value of Adjuvant Radiotherapy for Thymoma with Myasthenia Gravis after Extended Thymectomy

“…[ 24 25 ] Some experts questioned if routine adjuvant radiation therapy after complete resection would be helpful in long-term survival. [ 26 27 28 ] In our study, Kaplan-Meier survival curves demonstrate that within 8 years after surgery, there was no significant difference in aspects of overall survival [ Figure 2 ] and disease-free survival among three groups [ Figure 3 ]. However, 8 years after surgery, there was a trend that the disease-free survival rate in 1-month subgroup (79.4%) has become higher than those in 3-month subgroup (70.6%) and Group B (55.3%).…”

Minimally invasive surgery in the management of resectable thymoma: a retrospective analysis from the National Cancer Database

“…Data from these studies are heterogenous at best in that it included resections of benign or involuted thymus for symptomatic control of Myasthenia Gravis (14-28). However, few reports exist to determine whether minimally-invasive techniques have similar efficacy as sternotomy when looking at oncologic determinants such as operative margins (5,6,28,29). To this end, the NCDB provides a robust patient population for comparison.…”

Outcomes of Extended Thymectomy in Myasthenic and Non-Myasthenic Thymus Tumors

“…Literatürde beş yıllık hastalıksız sağkalım %83,3 ile %96 arasında değişmektedir 19,20 . Son yıllardaki yayınlarda Masaoka evre I ve II timomalı hastaların beş yıllık sağkalım oranının sırasıyla %89 ila %100 ve %71 ila %95 arasında olduğu ortaya konmuştur 21 .…”