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Ke L, Liu J, Shuai Y, Zhu L, He C, Huang X, Lv W, Wang L, Hu J. Intercostal approach VATS is feasible for large-sized anterior mediastinal tumors. Sci Rep 2024; 14:17227. [PMID: 39060332 PMCID: PMC11282267 DOI: 10.1038/s41598-024-67830-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2024] [Accepted: 07/16/2024] [Indexed: 07/28/2024] Open
Abstract
There is no consensus about whether relatively large mediastinal tumors (≥ 5.0 cm) are suitable for video-assisted thoracoscopic surgery (VATS). Therefore, this study aimed to compare the efficacy and safety of intercostal approach VATS for large-sized anterior mediastinal tumors (5.0-10.0 cm) with no invasion to the surrounding tissues and organs. A total of 129 patients with anterior mediastinal tumors who received surgery in our hospital between January 2018 and July 2022 were consecutively enrolled. Patients were divided into 2 groups based on mediastinal tumor diameter: Group A (tumor size between 1.0 and 4.9 cm) and Group B (tumor size between 5.0 and 10.0 cm). The primary endpoints were operation time, blood loss, and postoperative pain, and the secondary endpoints were the volume of drainage, drainage duration, postoperative hospital stay, and postoperative complications. Significant differences were found in the volume of drainage between the two groups (Group A: 218.4 ± 140.6, Group B: 398.9 ± 369.3, P < 0.001). However, no differences were found in operation time, blood loss, drainage duration, postoperative hospital stay and duration of postoperative oral analgesics (P > 0.05). In addition, there existed no significant differences in the postoperative complications. Intercostal approach VATS is regarded as a feasible and safe surgical method for large-sized anterior mediastinal tumors (5.0-10.0 cm) with no invasion to the surrounding tissues and organs.
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Affiliation(s)
- Lei Ke
- Department of Thoracic Surgery, The First Affiliated Hospital, Zhejiang University School of Medicine, No. 79 Qingchun Road, Hangzhou, 310003, China
| | - Jiacong Liu
- Department of Thoracic Surgery, The First Affiliated Hospital, Zhejiang University School of Medicine, No. 79 Qingchun Road, Hangzhou, 310003, China
| | - Yongfeng Shuai
- Department of Plastic Surgery, The Second Hospital of Yinzhou, Ningbo, 315000, China
| | - Linhai Zhu
- Department of Thoracic Surgery, The First Affiliated Hospital, Zhejiang University School of Medicine, No. 79 Qingchun Road, Hangzhou, 310003, China.
| | - Cheng He
- Department of Thoracic Surgery, The First Affiliated Hospital, Zhejiang University School of Medicine, No. 79 Qingchun Road, Hangzhou, 310003, China
| | - Xuhua Huang
- Department of Thoracic Surgery, The First Affiliated Hospital, Zhejiang University School of Medicine, No. 79 Qingchun Road, Hangzhou, 310003, China
| | - Wang Lv
- Department of Thoracic Surgery, The First Affiliated Hospital, Zhejiang University School of Medicine, No. 79 Qingchun Road, Hangzhou, 310003, China
| | - Luming Wang
- Department of Thoracic Surgery, The First Affiliated Hospital, Zhejiang University School of Medicine, No. 79 Qingchun Road, Hangzhou, 310003, China.
| | - Jian Hu
- Department of Thoracic Surgery, The First Affiliated Hospital, Zhejiang University School of Medicine, No. 79 Qingchun Road, Hangzhou, 310003, China.
- Key Laboratory of Clinical Evaluation Technology for Medical Device of Zhejiang Province, Hangzhou, 310003, China.
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Civan C, Ozkan ZG, Ozkan B, Isik EG, Erdogdu E, Has Simsek D, Duman S, Sanli Y, Kara M, Kuyumcu S, Toker A. The Role of [ 18F]FDG PET/CT in the Characterization of Thymic Epithelial Tumors at Initial Stage. Cancer Biother Radiopharm 2024; 39:373-380. [PMID: 38484307 DOI: 10.1089/cbr.2023.0192] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/28/2024] Open
Abstract
Purpose: The aim of this study was to evaluate the potential role of [18F]FDG positron emission tomography/computed tomography (PET/CT) in the characterization of thymic epithelial tumors (TETs). Materials and Methods: A total of 73 patients who underwent preoperative [18F]FDG PET/CT were included in this study. Visual total score (VTS), maximum standard uptake values (SUVmax), metabolic tumor volume (MTV), total lesion glycolysis (TLG), and heterogeneity index (HI) parameters were analyzed to investigate the prediction of histopathologic grade and advanced stage. Results: The cohort included 26 patients with low-grade thymoma (LGT), 36 patients with high-grade thymoma (HGT), and 11 patients with thymic carcinoma (TC). Ninety-one percent of TC had VTS >2, whereas 31% of LGT and 75% of HGT had VTS >2. SUVmax, MTV, and TLG were statistically significantly higher in the TC group than in both thymoma and HGT. Using the cutoff value of 7.25 for SUVmax, TC was differentiated from thymomas with 91% sensitivity and 74% specificity. TC had significantly lower HI values than thymomas. HI parameters showed good diagnostic ability to differentiate TC from thymoma and TC from HGT. SUVmax, MTV, and TLG were significantly higher in advanced-stage disease than in early-stage disease. Conclusions: Visual and quantitative parameters can reliably predict both advanced disease and the grade of primary tumor in TETs. Therefore, as a promising metabolic imaging method, [18F]FDG PET/CT makes important contributions to preoperative evaluation in routine clinical practice.
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Affiliation(s)
- Caner Civan
- Department of Nuclear Medicine and Istanbul Faculty of Medicine, Istanbul UniversityIstanbul, Türkiye
| | - Zeynep Gozde Ozkan
- Department of Nuclear Medicine and Istanbul Faculty of Medicine, Istanbul UniversityIstanbul, Türkiye
| | - Berker Ozkan
- Department of Thoracic Surgery, Istanbul Faculty of Medicine, Istanbul UniversityIstanbul, Türkiye
| | - Emine Goknur Isik
- Department of Nuclear Medicine and Istanbul Faculty of Medicine, Istanbul UniversityIstanbul, Türkiye
| | - Eren Erdogdu
- Department of Thoracic Surgery, Istanbul Faculty of Medicine, Istanbul UniversityIstanbul, Türkiye
| | - Duygu Has Simsek
- Department of Nuclear Medicine and Istanbul Faculty of Medicine, Istanbul UniversityIstanbul, Türkiye
| | - Salih Duman
- Department of Thoracic Surgery, Istanbul Faculty of Medicine, Istanbul UniversityIstanbul, Türkiye
| | - Yasemin Sanli
- Department of Nuclear Medicine and Istanbul Faculty of Medicine, Istanbul UniversityIstanbul, Türkiye
| | - Murat Kara
- Department of Thoracic Surgery, Istanbul Faculty of Medicine, Istanbul UniversityIstanbul, Türkiye
| | - Serkan Kuyumcu
- Department of Nuclear Medicine and Istanbul Faculty of Medicine, Istanbul UniversityIstanbul, Türkiye
| | - Alper Toker
- Department of Thoracic Surgery, Istanbul Faculty of Medicine, Istanbul UniversityIstanbul, Türkiye
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Dhamija A, Kakuturu J, Hayanga JWA, Toker A. Difficult Decisions in Minimally Invasive Surgery of the Thymus. Cancers (Basel) 2021; 13:cancers13235887. [PMID: 34884996 PMCID: PMC8657073 DOI: 10.3390/cancers13235887] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Revised: 11/12/2021] [Accepted: 11/15/2021] [Indexed: 11/16/2022] Open
Abstract
A minimally invasive resection of thymomas has been accepted as standard of care in the last decade for early stage thymomas. This is somewhat controversial in terms of higher-staged thymomas and myasthenia gravis patients due to the prognostic importance of complete resections and the indolent characteristics of the disease process. Despite concerted efforts to standardize minimally invasive approaches, there is still controversy as to the extent of excision, approach of surgery, and the platform utilized. In this article, we aim to provide our surgical perspective of thymic resection and a review of the existing literature.
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Affiliation(s)
- Ankit Dhamija
- Department of Cardiothoracic Surgery, Stony Brook University, Stony Brook, NY 11794, USA;
| | - Jahnavi Kakuturu
- Department of Cardiovascular and Thoracic Surgery, West Virginia University School of Medicine Morgantown, Morgantown, WV 26506, USA; (J.K.); (J.W.A.H.)
| | - J. W. Awori Hayanga
- Department of Cardiovascular and Thoracic Surgery, West Virginia University School of Medicine Morgantown, Morgantown, WV 26506, USA; (J.K.); (J.W.A.H.)
| | - Alper Toker
- Department of Cardiovascular and Thoracic Surgery, West Virginia University School of Medicine Morgantown, Morgantown, WV 26506, USA; (J.K.); (J.W.A.H.)
- Correspondence: ; Tel.: +1-304-282-0264
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Kumar A, Asaf BB, Pulle MV, Puri HV, Sethi N, Bishnoi S. Myasthenia is a poor prognostic factor for perioperative outcomes after robotic thymectomy for thymoma. Eur J Cardiothorac Surg 2021; 59:807-813. [PMID: 33279991 DOI: 10.1093/ejcts/ezaa406] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Revised: 09/25/2020] [Accepted: 09/30/2020] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVES The goal of this study was to compare the early and intermediate surgical outcomes, including the survival of those with and without myasthenic thymoma, following robotic thymectomy. METHODS This is a retrospective analysis of prospectively maintained data of 111 patients who underwent robotic thymectomy for thymoma over 7 years in a thoracic surgery centre in India. We performed a comparative analysis of demographics, intraoperative variables and postoperative outcomes including survival of those with and without myasthenic thymoma. RESULTS Of 111 patients, 68 patients were myasthenic and 43 were non-myasthenic. The need to resect surrounding structures and conversions was greater in the myasthenic group (P = 0.02, P = 0.04). Postoperative complications were significantly higher in the myasthenic group (P = 0.02). No differences were observed in intensive care unit stay, the need for postoperative ventilation and the hospital stay. On correlation, a higher Masaoka stage [odds ratio 1.96, 95% confidence interval (CI) 1.22-3.15] and an aggressive World Health Organization histological diagnosis (odds ratio 1.58, 95% CI 1.10-2.26) were more likely in patients with myasthenia gravis. A total of 7 deaths (6.3%) occurred during the median follow-up of 4.2 years, 5 among those with myasthenic thymoma and 2 among patients with non-myasthenic thymoma. Due to the small number of deaths, there is insufficient evidence to draw any conclusion about the effect of myasthenia gravis on survival after surgery (hazard ratio 0.51, 95% CI 0.09-2.71; P = 0.43). CONCLUSIONS The presence of myasthenia with thymoma is associated with more adjacent structure resection, higher postoperative complications and more conversions. The use of robotic surgery for thymoma resection in patients with myasthenia could not overcome the early postoperative problems related to myasthenia gravis.
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Affiliation(s)
- Arvind Kumar
- Centre for Chest Surgery, Sir Ganga Ram Hospital, New Delhi, India
| | - Belal Bin Asaf
- Centre for Chest Surgery, Sir Ganga Ram Hospital, New Delhi, India
| | | | | | - Nitin Sethi
- Department of Anaesthesia, Sir Ganga Ram Hospital, New Delhi, India
| | - Sukhram Bishnoi
- Centre for Chest Surgery, Sir Ganga Ram Hospital, New Delhi, India
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Abstract
Kido and colleagues in 1999 used for the first time the subxiphoid approach. Recently, video-assisted thoracoscopic surgery (VATS) thymectomy has been improved for the advancement of surgical materials and new instruments. The most important aspect regarding the subxiphoid approach is the possibility to avoid the intercostal nerve damage with the consequence of a decreased use of postoperative analgesics, quite short surgical duration, fast discharge from hospital and a guarantee of successful cosmetics results.
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Friedant AJ, Handorf EA, Su S, Scott WJ. Minimally Invasive versus Open Thymectomy for Thymic Malignancies: Systematic Review and Meta-Analysis. J Thorac Oncol 2016; 11:30-8. [PMID: 26762737 DOI: 10.1016/j.jtho.2015.08.004] [Citation(s) in RCA: 92] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2015] [Revised: 07/27/2015] [Accepted: 08/24/2015] [Indexed: 12/17/2022]
Abstract
Complete resection is the standard of care for treatment of thymic malignancies. The use of minimally invasive surgery remains controversial. We searched online databases and identified studies from 1995 to 2014 that compared minimally invasive to open thymectomy for thymic malignancies. Study end points included operative blood loss, operative time, respiratory complications, cardiac complications, length of hospital stay, R0 resection, and recurrence. We summarized outcomes across studies using random-effects meta-analysis to account for study heterogeneity. We calculated ORs for binary outcomes and standardized mean differences for continuous outcomes. We calculated incidence rate ratios for the number of recurrences, accounting for total person-time observed in each study. Of 516 potential reference studies, 30 with a total of 2038 patients met the inclusion criteria. Patients with Masaoka stage I or II thymic malignancy constituted 94.89% of those in the minimally invasive surgery (MIS) group and 78.62% of those in open thymectomy (open) group. Mean tumor size was 4.09 cm (MIS) versus 4.80 (open). Of the 1355 MIS cases, 32 were converted to open cases. Patients in the MIS group had significantly less blood loss; however, no significant differences in operating time, respiratory complications, cardiac complications, or overall complications were identified. Length of stay was shorter for patients in the MIS group. When patients with Masaoka stage I and II thymic malignancy only were analyzed, there was no difference in rate of R0 resection or overall recurrence rate. One postoperative death occurred in the open group. The results of this unadjusted meta-analysis of published reports comparing minimally invasive with open thymectomy suggest that in selected patients with thymic malignancy, minimally invasive thymectomy is safe and can achieve oncologic outcomes similar to those of open thymectomy.
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Affiliation(s)
| | | | - Stacey Su
- Temple Fox Chase Cancer Center, Philadelphia, PA, USA
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Nose N, Higuchi K, Chosa E, Ayabe T, Tomita M, Nakamura K. Port-site implantation of Type A Masaoka Stage I thymoma after video-assisted thoracic surgery: a case report. J Surg Case Rep 2016; 2016:rjw164. [PMID: 27672105 PMCID: PMC5036355 DOI: 10.1093/jscr/rjw164] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
A 60-year-old woman was referred to our hospital with an anterior mediastinal tumor measuring 3.5 cm in diameter on computed tomography (CT). We performed tumor resection by video-assisted thoracic surgery (VATS) with three ports. The final diagnosis was Type A Masaoka Stage I thymoma. On follow-up CT performed 36 months after the operation, two pleural tumors were detected at the port sites through which the forceps and ultrasonic scalpel had passed repeatedly during the operation. We therefore performed a second operation and enucleated the tumors while preserving the ribs. However, other tumor tissue was detected along the surgical marginal line during the pathological diagnosis after the operation. Surgeons should thus be aware that port-site recurrence can occur after VATS resection of Type A thymoma, despite its mild biological behavior. Wide resection of the chest wall is therefore recommended for operations of port-site recurrence after VATS thymectomy.
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Affiliation(s)
- Naohiro Nose
- Division of Thoracic and Breast Surgery, Department of Surgery Faculty of Medicine, University Of Miyazaki, 5200 Kiyotake, Miyazaki 889-1692, Japan
| | - Kazuhiro Higuchi
- Division of Thoracic and Breast Surgery, Department of Surgery Faculty of Medicine, University Of Miyazaki, 5200 Kiyotake, Miyazaki 889-1692, Japan
| | - Eiichi Chosa
- Division of Thoracic and Breast Surgery, Department of Surgery Faculty of Medicine, University Of Miyazaki, 5200 Kiyotake, Miyazaki 889-1692, Japan
| | - Takanori Ayabe
- Division of Thoracic and Breast Surgery, Department of Surgery Faculty of Medicine, University Of Miyazaki, 5200 Kiyotake, Miyazaki 889-1692, Japan
| | - Masaki Tomita
- Division of Thoracic and Breast Surgery, Department of Surgery Faculty of Medicine, University Of Miyazaki, 5200 Kiyotake, Miyazaki 889-1692, Japan
| | - Kunihide Nakamura
- Division of Thoracic and Breast Surgery, Department of Surgery Faculty of Medicine, University Of Miyazaki, 5200 Kiyotake, Miyazaki 889-1692, Japan
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Odaka M, Shibasaki T, Kato D, Mori S, Asano H, Yamashita M, Morikawa T. Comparison of oncological results for early- and advanced-stage thymomas: thoracoscopic thymectomy versus open thymectomy. Surg Endosc 2016; 31:734-742. [DOI: 10.1007/s00464-016-5027-2] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2015] [Accepted: 06/06/2016] [Indexed: 11/28/2022]
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Toker A. Standardized definitions and policies of minimally invasive thymoma resection. Ann Cardiothorac Surg 2015; 4:535-9. [PMID: 26693149 DOI: 10.3978/j.issn.2225-319x.2015.10.02] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
A wide range of technical approaches for the minimally invasive resection of thymus have been described. Most of the time, the benefits are superior cosmetic outcome and shorter duration of postoperative stay. Other demonstrable differences that have been reported include shorter duration of surgery, less intraoperative blood loss and less postoperative pleural drainage. Robotic surgery and video-assisted surgery (VATS) may become routinely used procedures in the treatment of stage I and II thymomas.
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Affiliation(s)
- Alper Toker
- 1 Department of Thoracic Surgery, Istanbul Medical School, Istanbul University, Istanbul, Turkey ; 2 Department of Thoracic Surgery, Group Florence Nightingale Hospitals, Istanbul, Turkey
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Odaka M, Shibasaki T, Asano H, Marushima H, Yamashita M, Morikawa T. Feasibility of thoracoscopic thymectomy for treatment of early-stage thymoma. Asian J Endosc Surg 2015; 8:439-44. [PMID: 26094717 DOI: 10.1111/ases.12202] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2015] [Revised: 05/15/2015] [Accepted: 05/18/2015] [Indexed: 11/29/2022]
Abstract
INTRODUCTION The objective of this study was to evaluate the feasibility of thoracoscopic thymectomy (TT) for treatment of early-stage thymoma and to compare the outcomes with those after open thymectomy (OT). METHODS A retrospective review of 98 patients who underwent TT or OT of Masaoka stage I-II thymoma without thymic cancer between 1996 and 2013 was performed. RESULTS Thoracoscopic thymectomy was performed in 67 patients, and OT was performed in 31 patients. The intraoperative blood loss amounts differed significantly between the TT group and OT group (100 vs 185 mL, P = 0.0070). The postoperative hospital stay was significantly shorter in the TT group than in the OT group (4 vs 12 days, P < 0.0001). No patient in the TT group underwent conversion to open surgery, and no surgical complications, such as massive bleeding, were observed. Two patients experienced recurrence in the TT group during the median postoperative follow-up period of 65 months. No significant differences were found in the 5-year disease-free survival rates between the two groups. There were no significant differences in disease-free survival as classified by Masaoka stage, World Health Organization type, and the extent of resection of the thymus. CONCLUSION Our outcome showed that TT largely reduced the degree of invasiveness. The outcome was not inferior to that of OT. The results primarily demonstrated the feasibility of TT for treatment of early-stage thymoma.
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Affiliation(s)
- Makoto Odaka
- Department of Surgery, Jikei University School of Medicine, Tokyo, Japan
| | - Takamasa Shibasaki
- Department of Surgery, Jikei University School of Medicine, Tokyo, Japan
| | - Hisatoshi Asano
- Department of Surgery, Jikei University School of Medicine, Tokyo, Japan
| | - Hideki Marushima
- Department of Surgery, Jikei University School of Medicine, Tokyo, Japan
| | - Makoto Yamashita
- Department of Surgery, Jikei University School of Medicine, Tokyo, Japan
| | - Toshiaki Morikawa
- Department of Surgery, Jikei University School of Medicine, Tokyo, Japan
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Fonseca AL, Ozgediz DE, Christison-Lagay ER, Detterbeck FC, Caty MG. Pediatric thymomas: report of two cases and comprehensive review of the literature. Pediatr Surg Int 2014; 30:275-86. [PMID: 24322668 DOI: 10.1007/s00383-013-3438-x] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/27/2013] [Indexed: 11/29/2022]
Abstract
PURPOSE Thymomas are rare pediatric malignancies with indolent behavior. There are fewer than 50 reported cases and no comprehensive review. We sought to evaluate our recent experience with pediatric thymomas, and comprehensively review the extant literature. METHODS A systematic search of the PubMed database was performed using keywords: "thymoma", "pediatric", "juvenile", "childhood", and "child". Additional studies were identified by a manual search of the reference list. RESULTS We report two patients with thymomas. We identified 22 case reports or series that described 48 patients; 62 % were male, 15 % presented with myasthenia gravis. Fifty percent were Masaoka Stage I, 15 % were Stage II, 13 % were Stage III, and 23 % were Stage IV. Four patients with early stage (I or II) disease were treated with adjuvant therapies in addition to surgical excision, while five patients with late stage (III or IV) disease treated with surgical excision alone. Of studies reporting at least 2-year follow-up, survival was 71 %. CONCLUSION Pediatric thymomas are rare tumors with a slight male predominance. Wide variations were observed in the treatment of thymomas across all stages. Our review indicates a need for large database and multi-institutional studies to clearly elucidate clinical course, prognostic factors and outcome.
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Affiliation(s)
- Annabelle L Fonseca
- Department of Pediatric Surgery, Yale School of Medicine, FMB 107, 333 Cedar Street, New Haven, CT, 06511, USA,
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