Surgical approach in thymectomy: Our experience and review of the literature

Abstract

AimThymectomy is the main treatment for thymoma and patients with myasthenia gravis (MG). The traditional approach is through a median sternotomy, but, recently, thymectomy through minimally invasive approaches is increasingly performed. Our purpose is an analysis and discussion of the clinical presentation, the diagnostic procedures and the surgical technique. We also consider post-operative complications and results, over a period of 5 years (May 2011–June 2016), in thymic masses admitted in our Thoracic Surgery Unit.MethodsWe analyzed 8 patients who underwent surgical treatment for thymic masses over a period of 5 years. 6 patients (75%) had thymoma, 2 patients (25%) had thymic carcinomas. 2 patients with thymoma (33%) had myasthenia gravis. We performed a complete surgical resection with median sternotomy as standard approach.ResultsOne patient (12%) died in the postoperative period. The histological study revealed 6 (75%) thymoma and 2 (25%) thymic carcinomas. Post-operative morbidity occurred in 2 patients (25%) and were: pneumonia in 1 case (12%), atrial fibrillation and pleural effusion in 2 patients (25%). One patient with thymoma type A recurred at skeletal muscle 2-years after surgery.ConclusionsThymic malignancies are rare tumors. Surgical resection is the main treatment, but a multimodal approach is useful for many patients. Radical thymectomy is completed removing all the soft tissue in the anterior mediastinum between the two phrenic nerves and this is the most important factor in controlling myasthenia and influencing survival in patients with thymoma. Open (median sternotomy) approach has been the standard approach for thymectomy for the better visualization of the anatomical structures. Actually, video-assisted thoracoscopic surgery (VATS) thymectomy and robotic video-assisted thoracoscopic (R-VATS) approach versus open surgery has an equal if not superior oncological efficacy, better perioperative complications and survival outcomes.

Comparison of the Outcomes Between Bilateral Thoracoscopic Maximal Thymectomy Versus Trans-Sternal Maximal Thymectomy for Non-Thyomomatous Myasthenia Gravis Patients: A Local University Hospital Experience

“…The current results of our study found that there is no difference between BTT and TS concerning complete stable remission, while the results of two other studies [ 7 , 16 ] indicated that VATS has more complete stable remission compared to TS. Our results also reported no statistical difference between the two groups regarding pharmacological remission, which disagrees with Bachmann et al [ 1 ], who mentioned that VATS has less pharmacological remission than TS.…”

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

“…After complete resection, patients with thymoma have a very low rate of recurrence. [ 28 29 30 ] Unlike other malignant tumors, such as lung cancer, most recurrences or metastases of thymoma happened in pleural cavity. There were also occasional recurrences or metastases to lung or liver.…”

Primary Thymus Tumors: Retrospective Case Analysis at a Reference Center in Latin America, 2011 – 2019

“…All soft tissue should be removed in the anterior mediastinum between the phrenic nerves, which is key to control patients who present with myasthenia gravis and positively impact in mortality. [17,18]. Thoracoscopy was the most utilized approach in our patients (66.6%), as it is minimally invasive and signi cantly reduces complication rate.…”