From the Guidelines
Thymoma removal should be performed through a complete surgical resection, preferably using an open median sternotomy approach, as it offers the best chance for cure, with five-year survival rates exceeding 90% for early-stage disease. The approach depends on the size and stage of the thymoma, and the goal is to completely remove the thymus gland along with the tumor and sometimes surrounding tissues if the cancer has spread 1.
Some key points to consider in thymoma removal include:
- Complete surgical resection is the standard of care, and it involves removing the entire thymus gland, including all mediastinal tissues anterior to the pericardium, aorta, and superior vena cava from the phrenic nerve to the phrenic nerve laterally and from the diaphragm inferiorly to the level of the thyroid gland superiorly, including the upper poles of the thymus 1.
- Minimally invasive approaches, such as video-assisted thoracic surgery, are not considered the standard of care and are not recommended at this time, as long-term data on recurrence and survival are not available 1.
- The Masaoka staging system is the most widely accepted system for management and determination of prognosis for both thymomas and thymic carcinomas, and it can help guide treatment decisions 1.
- Patients with stage I to III thymomas have a 5-year survival rate of approximately 85%, versus 65% for stage IV disease, highlighting the importance of early detection and treatment 1.
- Thymectomy is crucial because thymomas can be malignant and may be associated with autoimmune disorders like myasthenia gravis, and complete surgical removal offers the best chance for cure 1.
Follow-up care includes regular imaging studies every 6-12 months to monitor for recurrence, and pain management usually involves prescription medications like oxycodone or hydrocodone for 3-7 days, then transitioning to over-the-counter options like acetaminophen or ibuprofen. Overall, the goal of thymoma removal is to achieve complete surgical resection, which offers the best chance for cure and improved survival rates.
From the Research
Thymoma Removal Techniques
- Video-assisted thoracic surgery (VATS) thymectomy is a minimally invasive approach for thymoma removal, which has evolved significantly over the last decade 2.
- VATS thymectomy results in less postoperative pain, better preserved pulmonary function, and improved cosmesis compared to conventional surgical techniques 2.
Comparison of VATS and Trans-sternal Thymectomy
- Studies have compared the outcomes of VATS thymectomy and trans-sternal thymectomy for Masaoka stage I and II thymoma, showing that VATS thymectomy is technically feasible and safe, with a shorter duration of surgery, less intraoperative blood loss, and shorter postoperative hospital stay 3, 4.
- The oncologic outcomes of VATS thymectomy and trans-sternal thymectomy are comparable, with similar rates of complete stable remission and asymptomatic disease 5, 4.
Outcomes of VATS Thymectomy for Thymoma-associated Myasthenia Gravis
- VATS thymectomy has been shown to be effective in treating thymoma-associated myasthenia gravis, with significant improvements in symptoms and quality of life 3, 6.
- The complete stable remission rate after VATS thymectomy for thymoma-associated myasthenia gravis has been reported to be around 26.7% to 28% at 5 years, with an asymptomatic disease rate of 59% at 5 years 5, 3.
Safety and Efficacy of VATS Thymectomy
- VATS thymectomy has been shown to be safe and effective, with a low rate of intraoperative complications and postoperative morbidity 4, 6.
- The approach can be applicable for patients of all age groups with thymomas at early Masaoka's stages, with a lower rate of conversion to open surgery and shorter hospitalization 6.