Epidemiology of thymic epithelial tumors: 22-years experience from a single-institution.

BACKGROUND: To assess the correlation of WHO histological classification and Masaoka-Koga staging system of thymic epithelial tumors (TETs) with prognosis. METHODS: We retrospectively analyzed 83 patients with TETs in the Instituto Nacional de Enfermedades Neoplasicas between 1996 to 2018. We analyzed the clinical stages, histological types and treatment modalities and attempted to determine the impact on overall survival. The data was retrieved from clinical files and reviewed by a pathologist who reclassificated according to the 2004 WHO classification system. The staging was performed with the Masaoka-Koga staging system. Survival curves were constructed with Kaplan-Meir method. RESULTS: There was a total of 83 patients with a median age of 55 years old included in the study. The histological type corresponded to thymoma (T) in 63.8% (n = 53) and to thymic carcinoma (TC) in 36.1%. T were type A, AB, B1, B2 and B3 in 14.4%, 18%, 12%, 3.6%, 7.4% of cases, respectively. The proportion of advanced disease (Masaoka stage III-IV) was high (65%). With a median follow-up of 88.4 months, median overall survival (OS) was 81.6 months for T and 12.3 months for TC (P = 0.01). Univariate analysis showed that sex, histological type, clinical stage and surgery (P = 0.01) were significant independent prognostic factors. On multivariate analysis, histology type and Masaoka-Koga staging had an effect on survival. CONCLUSIONS: The results indicates a clear association between the WHO histological classification and Masaoka-Koga staging system with survival. We found a higher proportion of TETs with advanced disease at diagnosis. Further research are required and collaboration is important to foster knowledge focused on classification and treatment. KEY POINTS: SIGNIFICANT FINDINGS OF THE STUDY: The WHO histological classification, the Masaoka-Koga system and surgery treatment were associated with overall survival. WHAT THIS STUDY ADDS: To determine prognosis factors in TETs.

Manejo de la injuria quirúrgica del conducto torácico por toracoscopía asistida por video. Reporte de un caso y revisión de la literatura / Management of surgical injury of thoracic duct by video-assisted thoracoscopy. A case report and literature review

La lesión del conducto torácico post operatorio, es una complicación poco frecuente, pero puede ocasionar grandes alteraciones metabólicas así como aumentar la morbilidad post quirúrgica. Las formas de tratamiento de estas complicaciones pueden ser médicas o quirúrgicas, prefiriéndose la opción quirúrgica en aquellas situaciones que se pierdan volúmenes importantes de líquido linfático. Una de las alternativas quirúrgicas es mediante video toracoscopia, con la cual se logra ligar en conducto torácico, sin la necesidad de realizar una toracotomía, cirugía más elaborada y conlleva potenciales complicaciones. A continuación presentamos un caso de sección quirúrgica de conducto torácico en el área del cuello y que resolvió por ligadura a través de video toracoscopia.

Disruption of the thoracic duct is rare complication post thoracic or neck surgery. The outcomes are metabolic complications. But it can account for many metabolic complications and increases the morbidity post-surgery. A quick approach to this problem is the video assisted thoracotomy and ligation of the thoracic duct. Which is a quick and with less co morbidities than classic thoracotomy and medical approach. In this review we present a case in which the thoracic duct was disrupted after neck surgery and the ligations of the duct by VATS approach.