Precis Future Med.  2020 Dec;4(4):149-160. 10.23838/pfm.2020.00163.

Surgical approach for the treatment of thymic carcinoma: 201 cases from a multi-institutional study

• Jeon YJ
• Choi YS
• Cho JH
• Kim HK
• Lee GD
• Kim DK
• Kang CH
• Kim YT
• Lee CY
• Lee JG
• other members of the Korean Association for Research on the Thymus (KART)

• KMID: 2511206
• DOI: http://doi.org/10.23838/pfm.2020.00163

Abstract

Purpose
This study aimed to compare the outcomes of surgical approach (video-assisted thoracoscopic surgery [VATS] vs. sternotomy vs. thoracotomy) for the treatment ofthymic carcinoma
Methods
We retrospectively reviewed 201 patients with pathologically proven thymic carcinoma who underwent surgicalresection atfour Korean institutions.
Results
From 2007 to 2013, 158 sternotomy, 33 VATS and 10 thoracotomy were conducted forthymic carcinoma. Open group underwent more preoperative biopsy (41.8% and 50% vs. 15.2%, P=0.012) and neoadjuvant treatment (22.2% and 30% vs. 0%, P=0.008) than VATS group. In preoperative imaging, tumor size of VATS group was smaller than sternotomy group (3.8±1.1 cm vs. 5.8±2 cm, P<0.05) and 91% of the VATS group was clinicaltumor-node-metastasis (TNM) stage I. The lengths of chesttube and mechanical ventilation duration, postoperative hospital day and intensive care unit stay were shorterin VATS group than open group (P<0.001). The incidence of postoperative complications of VATS group was lower than sternotomy group (P=0.014). The 5-year overall survival of the sternotomy, VATS and thoracotomy group were 100%, 100% and 87.5%±11.7%, respectively (P=0.107). The 5-year recurrence-free survival rate was not significantly different between the groups (55.4%±4.5%, 67.9%±12.1%, and 87.5%±11.7%; P=0.131)
Conclusion
The VATS approach of surgical treatment for thymic carcinoma can be selectively employed in small (<5 cm) and TNM stage I tumor without compromise of oncologic outcome.

Keyword

Thymus neoplasms; Carcinoma; Thoracic surgery, video-assisted