ABSTRACT
Background and
Objective:
Thymic epithelial
tumors (TETs) are scarce
neoplasms of the prevascular
mediastinum. Included in this diverse category of lesions are
thymomas and
thymic carcinomas (TCs).
Surgery is the mainstay of
treatment of
tumors that are deemed resectable. However, up till now, optimal surgical access has been a subject of debate. The advent of new
techniques, such as
video-assisted thoracoscopic surgery (
VATS) and robotic-assisted
thoracoscopic surgery (
RATS), challenged the
median sternotomy which was traditionally considered the access of choice. This
review aims to demonstrate the current evidence concerning the surgical
treatment of TET and to enlighten other controversial issues about
surgery.
Methods:
PubMed research was conducted using the terms [
surgery] AND [thymic epithelial
tumors] OR [
thymomas] and [surgical
treatment] AND [thymic epithelial
tumors] OR [
thymomas].
Papers concerning pediatric cases and non-English
literature papers were excluded. Individual
case reports were also excluded. Key Content and
Findings:
Minimally invasive surgical
techniques (
MIST) such as
VATS and
RATS are increasingly applied in early-stage TET. Although numerous published studies have demonstrated better perioperative outcomes in early-stage TET, long-term follow-up data are still required to demonstrate the oncological equivalent of
MIST to open
surgery. Resection of stage III TET is more challenging.
Thymectomy can be expanded en bloc to include the major vascular structures,
lung,
pleura, phrenic, or
vagus nerve in these individuals. There is no agreement on the ideal surgical access and traditionally these
patients underwent open
sternotomy, sometimes combined with a thoracic access. Evidence concerning the
treatment of stage IVA
disease is mainly derived from retrospective case series which are highly heterogeneous in terms of the number of enrolled
patients,
histology, degree of pleural involvement, and timing of presentation.
Conclusions:
New
techniques in the field of
minimally invasive surgery are gaining acceptance for early-stage TET but longer follow-up periods are warranted to prove their oncological outcomes. On the contrary, these
techniques should be used cautiously in case of locally advanced
tumors.
Surgeons must not forget that the main objective is the complete resection of the lesion, which is one major predictive factor for increased
survival.
