Video-assisted thoracoscopy versus open approach in patients with Masaoka stage III thymic epithelial tumors

Abstract

Background The treatment options for Masaoka stage III thymic epithelial tumors are diverse, mainly because the lesions infiltrate the neighboring organs, major vascular structures, with different scopes, extents, and manners. Surgical treatment is the main treatment for the patient in this stage. However, for minimally invasive or open surgery, the current controversy remains large. This study aimed to investigate the feasibility and indications of minimally invasive resection in the treatment of stage III thymic tumors. Methods Twenty-six patients with Masaoka stage III thymic tumors who underwent surgery were enrolled in the study. Among them, group A with 8 patients underwent thoracoscopic resection and group B with 18 patients (including one open-converted patient) underwent semi-sternotomy or full-sternotomy resection. The groups were compared with each other in terms of the characteristics of patients, tumors, and perioperative period. Results There were no significant differences in patients’ characteristics, WHO classification, and complications between the two groups (P>0.05), but the tumors in group B were significantly larger than those in group A (P<0.05). In group B, the lesions infiltrated the superior vena cava and the phrenic nerve more frequently than that of group A (P<0.05). There was no significant difference between the two groups in the involvement of left innominate vein, pericardium, and lung (P>0.05). Tumor size, the involvement of superior vena cava and phrenic nerve were important factors in the determination of minimally invasive surgery for Masaoka stage III thymic tumor (P<0.05). Conclusions For Masaoka stage III thymic tumors, neighboring organs involved were noted to be important factors in successful minimally invasive tumor resection. Tumor size and involvement of phrenic nerve and superior vena cava were found to be the variables that hindered successful video-assisted thoracoscopy (VATS) resection. Thus, minimally invasive resection is acceptable in the treatment of selected cases of Masaoka stage III thymic tumors.

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

“…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].…”

Prognostic CT features in patients with untreated thymic epithelial tumors

“…However, the Masaoka system is a surgical-pathologic staging system which is de ned after surgical resection, and no agreement has been reached to de ne the clinical stage before surgery in TETs at present. Although empiric evidence has led surgical resection to be the predominant therapy in TETs and complete resection is a consistent prognostic factor [10][11][12] , still some patients with high-risk thymomas and thymic carcinomas are hardly to receive complete resection and need multimodal therapy approaches including neoadjuvant chemotherapy or radiotherapy 13 .…”