Unilateral thoracoscopic subtotal thymectomy for the treatment of stage I and II thymoma

Odaka, Makoto; Akiba, Tadashi; Yabe, Mitsuo; Hiramatsu, Masayuki; Matsudaira, Hideki; Hirano, Jun; Morikawa, Toshiaki

doi:10.1016/j.ejcts.2009.10.003

Cited by 66 publications

(60 citation statements)

References 22 publications

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“…However, it must be clearly stated, that such events occur rarely, usually in less than 10% of patients undergoing thymectomy for thymoma without MG (23,24). On the other hand, some authors proposed subtotal thymectomy in the Masaoka stage I and II thymomas in cases without associated MG (25). However, most of the authors advice to perform a complete thymectomy in thymomas with MG. Thymomas, contrary to the thymic cancer rarely metastasize to the mediastinal lymph nodes, therefore the role of lymphadenectomy of the mediastinum for thymomas is not clear.…”

Section: Indications For Minimally Invasive Thymectomy In Thymoma Witmentioning

confidence: 96%

Definitions and standard indications of minimally-invasive techniques in thymic surgery

Zieliński

2017

J. Vis. Surg.

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Background: The minimally invasive thoracic procedures are those performed through the intercostal, subxiphoid, subcostal or transcervical incisions. In most of these procedures (with exception of some transcervical procedures) the video-assisted thoracic surgery (VATS) technique is used for performance of an operation under guidance of a video monitor.Methods: According to the definition the minimally invasive procedures do not include the sternal manubriotomy (upper sternal split), transverse sternotomy and subcutaneous longitudinal sternotomy.Currently, a minimally invasive extended thymectomy became a widespread procedure advised for nonthymomatous myasthenia gravis (MG) and early-stage thymomas. The definition of an extended thymectomy is a removal of the whole thymus with the surrounding adipose tissue. Instead of the term "extended thymectomy" some authors recommended a term "complete thymectomy", which means total removal of the whole thymus, without the adjacent fatty tissue.Results: There are a lot of doubts about the definition of extended thymectomy. There have been no prospective randomized trials comparing the transsternal and minimally invasive approaches for MG or thymomas. Possible scenarios for such trials are analyzed in this paper.Conclusions: There are several issues of a minimally invasive thymectomy for MG and thymomas necessitating further clarifications.

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Section: Indications For Minimally Invasive Thymectomy In Thymoma Witmentioning

confidence: 96%

Definitions and standard indications of minimally-invasive techniques in thymic surgery

Zieliński

2017

J. Vis. Surg.

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“…This controversy is, in part, due to the lack of proper definitions as to the meaning of "complete, extended, or maximal thymectomy (17)" and to the fact that some authors have suggested that sub-total thymectomy may be adequate surgery for the treatment of early stage thymomas (18). Not surprisingly, this controversy has mostly come up since the advent of minimally invasive approaches.…”

Section: Controversies In Surgical Managementmentioning

confidence: 98%

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

Rakovich

Deslauriers

2017

J. Vis. Surg.

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“…ET was usually performed in patients who had MG. For these patients, thoracoscopic ET was performed using a bilateral thoracic approach in our institution. STT was defined as the resection of the thymus without the superior and inferior poles in a contralateral thymic lobe (31). Total thymectomy and STT using a unilateral thoracic approach are the main thoracoscopic procedures for thymoma in our institution ( Figure 1).…”

Section: Surgical Treatmentmentioning

confidence: 99%

Surgical and oncological outcomes of thoracoscopic thymectomy for thymoma

Odaka¹,

Tsukamoto²,

Shibasaki³

et al. 2017

J. Vis. Surg.

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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...

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Unilateral thoracoscopic subtotal thymectomy for the treatment of stage I and II thymoma

Abstract: These preliminary results suggest that thoracoscopic thymectomy for Masaoka stage I and II thymoma is technically feasible and safe, and it is less invasive for the patient. Nevertheless, this procedure requires further investigation in a large series with a longer follow-up.

Cited by 66 publications

References 22 publications

Definitions and standard indications of minimally-invasive techniques in thymic surgery

Definitions and standard indications of minimally-invasive techniques in thymic surgery

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

Surgical and oncological outcomes of thoracoscopic thymectomy for thymoma

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