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Kocaman G, Kayi Cangir A. Early stage thymoma and the surgical extent paradigm. Updates Surg 2024:10.1007/s13304-024-01918-z. [PMID: 38913297 DOI: 10.1007/s13304-024-01918-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2024] [Accepted: 06/18/2024] [Indexed: 06/25/2024]
Abstract
The recommended treatment for early stage thymoma without myasthenia gravis is complete thymectomy (CT). Limited thymectomy (LT) (simply resecting the thymoma with safe surgical margins) is gaining popularity. In this study, we compared the surgical and oncological results of complete and limited thymectomy in non-myasthenic patients with early stage thymoma. Non-myasthenic, Masaoka stage I-II, 86 patients who underwent surgical resection for thymoma were included in the study. Complete thymectomy (n:44) included patients who had resection of the thymoma together with the entire thymus and limited thymectomy (n:42) included patients who had resection of the thymoma without remaining thymus. The surgical approach, tumor size, histological type, pathological stage, adjuvant therapy, complications, postop myasthenia gravis, recurrence and death were recorded and compared between groups. Complete thymectomy group had more WHO type B1-3 tumors, more complications and more deaths than patients in the limited thymectomy group (p = 0.03, 0.018 and 0.023 respectively). Although statistically not significant CT group had more recurrences than LT group (11.4%/4.8%, p = 0.43). The 10-year freedom from recurrence (FFR) rate in the CT group was 84.8% and in the LT group ıt was 97.6%, the difference was not statistically significant (p = 0.15). None of the factors including surgical extent analysed with univariate and multivariate analysis had a significant effect on FFR. Limited thymectomy may be a good treatment option for non-myasthenic early stage thymoma patients but randomized controlled trials with long follow-up periods, ideally comparing patients operated with minimally invasive surgery are necessary.
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Affiliation(s)
- Gökhan Kocaman
- Thoracic Surgery Department, Faculty İbn-I Sina Hospital, Ankara University School of Medicine, 06100, Sıhhiye, Ankara, Turkey.
| | - Ayten Kayi Cangir
- Thoracic Surgery Department, Faculty İbn-I Sina Hospital, Ankara University School of Medicine, 06100, Sıhhiye, Ankara, Turkey
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2
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Chung HY, Shin HY, Choi Y, Park HJ, Lee JG, Lee CY, Park BJ, Kim GJ, Kim SW. Germinal centers are associated with postthymectomy myasthenia gravis in patients with thymoma. Eur J Neurol 2024; 31:e16119. [PMID: 37909803 PMCID: PMC11235914 DOI: 10.1111/ene.16119] [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: 02/17/2023] [Revised: 10/11/2023] [Accepted: 10/12/2023] [Indexed: 11/03/2023]
Abstract
BACKGROUND AND PURPOSE Germinal centers (GCs) can be observed in the thymic tissues of patients with thymoma-associated myasthenia gravis (MG). Although an association between thymic GCs and MG has been suggested, it is unknown whether the presence of GCs could predict the development of MG after the resection of thymoma, known as postthymectomy MG. METHODS We conducted a retrospective analysis of previously nonmyasthenic patients who underwent surgical removal of the thymoma. All available thymic tissue slides were rereviewed by a pathologist to assess for GCs. Patients were classified into GC-positive and GC-negative groups based on the presence of GCs. The incidence of postthymectomy MG was compared between the two groups, and the risk factors for postthymectomy MG were assessed. RESULTS Of the 196 previously nonmyasthenic patients who underwent thymoma resection, 21 were GC-positive, whereas 175 were GC-negative. Postthymectomy MG developed in 11 (5.6%) patients and showed a higher incidence in the GC-positive group than in the GC-negative group (33.3% vs. 2.3%, p < 0.001). No postoperative radiotherapy and the presence of GCs were risk factors for postthymectomy MG in the univariate analysis. In multivariate analysis, invasive thymoma (hazard ratio [HR] = 9.835, 95% confidence interval [CI] = 1.358-105.372), postoperative radiotherapy (HR = 0.160, 95% CI = 0.029-0.893), and presence of GCs (HR = 15.834, 95% CI = 3.742-67.000) were significantly associated with postthymectomy MG. CONCLUSIONS Thymic GCs may be a significant risk factor for postthymectomy MG. Even in patients with thymoma who do not show clinical symptoms of MG, postthymectomy MG should be considered, especially if thymic GCs are observed.
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Affiliation(s)
- Hye Yoon Chung
- Department of NeurologyYonsei University College of MedicineSeoulKorea
- Department of NeurologyYongin Severance Hospital, Yonsei University Health SystemYonginKorea
| | - Ha Young Shin
- Department of NeurologyYonsei University College of MedicineSeoulKorea
| | - Young‐Chul Choi
- Department of NeurologyYonsei University College of MedicineSeoulKorea
| | - Hyung Jun Park
- Department of NeurologyYonsei University College of MedicineSeoulKorea
| | - Jin Gu Lee
- Department of Thoracic and Cardiovascular SurgeryYonsei University College of MedicineSeoulKorea
| | - Chang Young Lee
- Department of Thoracic and Cardiovascular SurgeryYonsei University College of MedicineSeoulKorea
| | - Byung Jo Park
- Department of Thoracic and Cardiovascular SurgeryYonsei University College of MedicineSeoulKorea
| | - Gi Jeong Kim
- Department of PathologyYonsei University College of MedicineSeoulKorea
| | - Seung Woo Kim
- Department of NeurologyYonsei University College of MedicineSeoulKorea
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Xu C, Zhang Q, Li J, Qiu H, Zhu K, Chen D, Jin Z, Zhang J, Zhang B, Witharana P, Chen B, Xu E, Shen J. Prognosis and surgical outcomes of the total thymectomy versus thymomectomy in non-myasthenic patients with early-stage thymoma: A systematic review and meta-analysis. Asian J Surg 2023; 46:3455-3463. [PMID: 37005182 DOI: 10.1016/j.asjsur.2023.03.063] [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] [Received: 10/26/2022] [Revised: 12/21/2022] [Accepted: 03/15/2023] [Indexed: 04/03/2023] Open
Abstract
Whether thymectomy (TM) or thymomectomy (TMM) is better for non-myasthenic patients with early-stage thymoma. We conducted a meta-analysis to compare the clinical outcomes and prognoses of non-myasthenic patients with early-stage thymoma treated using thymectomy versus thymomectomy. PubMed, Embase, Cochrane Library and CNKI databases were systematically searched for relevant studies on the surgical treatment (TM and TMM) of non-myasthenic patients with early-stage thymoma published before March 2022. The Newcastle-Ottawa scale was used to evaluate the quality of the studies, and the data were analyzed using RevMan version 5.30. Fixed or random effect models were used for the meta-analysis depending on heterogeneity. Subgroup analyses were performed to compare short-term perioperative and long-term tumor outcomes. A total of 15 eligible studies, including 3023 patients, were identified in the electronic databases. Our analysis indicated that TMM patients might benefit from a shorter duration of surgery (p = 0.006), lower blood loss volume (p < 0.001), less postoperative drainage (p = 0.03), and a shorter hospital stay (p = 0.009). There were no significant differences in the overall survival rate (p = 0.47) or disease-free survival rate (p = 0.66) between the two surgery treatment groups. Likewise, TM and TMM were similar in the administration of adjuvant therapy (p = 0.29), resection completeness (p = 0.38), and postoperative thymoma recurrence (p = 0.99). Our study revealed that TMM might be a more appropriate option in treating non-myasthenic patients with early-stage thymoma.
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Affiliation(s)
- Congcong Xu
- Department of Cardiothoracic Surgery, Taizhou Hospital of Zhejiang Province Affiliated to Wenzhou Medical University, Linhai, 317000, Zhejiang Province, China
| | - Qipeng Zhang
- Department of Thoracic Surgery, General Hospital of Southern Theater Command, Guangzhou, 510010, Guangdong Province, China; The First School of Clinical Medicine, Southern Medical University, Guangzhou, 510515, Guangdong Province, China
| | - Jiawei Li
- Department of Cardiothoracic Surgery, Taizhou Hospital of Zhejiang Province Affiliated to Wenzhou Medical University, Linhai, 317000, Zhejiang Province, China
| | - Hongbin Qiu
- Department of Cardiothoracic Surgery, Taizhou Hospital of Zhejiang Province Affiliated to Wenzhou Medical University, Linhai, 317000, Zhejiang Province, China
| | - Kanghao Zhu
- Department of Cardiothoracic Surgery, Taizhou Hospital, Zhejiang University, Linhai, 317000, Zhejiang Province, China
| | - Dong Chen
- Department of Cardiothoracic Surgery, Taizhou Hospital of Zhejiang Province Affiliated to Wenzhou Medical University, Linhai, 317000, Zhejiang Province, China
| | - Zixian Jin
- Department of Cardiothoracic Surgery, Taizhou Hospital of Zhejiang Province Affiliated to Wenzhou Medical University, Linhai, 317000, Zhejiang Province, China
| | - Jian Zhang
- Department of Cardiothoracic Surgery, Taizhou Hospital of Zhejiang Province Affiliated to Wenzhou Medical University, Linhai, 317000, Zhejiang Province, China
| | - Bo Zhang
- Department of Cardiothoracic Surgery, Taizhou Hospital of Zhejiang Province Affiliated to Wenzhou Medical University, Linhai, 317000, Zhejiang Province, China
| | - Pasan Witharana
- Northern General Hospital, Herries Rd, Sheffield, S5 7AU, UK; Imperial College London, London, SW7 2BX, UK
| | - Baofu Chen
- Precision Medicine Center, Taizhou Central Hospital (Taizhou University Hospital), Department of Cardiothoracic Surgery, Taizhou, 318000, Zhejiang Province, China.
| | - Enwu Xu
- Department of Thoracic Surgery, General Hospital of Southern Theater Command, Guangzhou, 510010, Guangdong Province, China; The First School of Clinical Medicine, Southern Medical University, Guangzhou, 510515, Guangdong Province, China.
| | - Jianfei Shen
- Department of Cardiothoracic Surgery, Taizhou Hospital of Zhejiang Province Affiliated to Wenzhou Medical University, Linhai, 317000, Zhejiang Province, China.
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Falkson CB, Vella ET, Ellis PM, Maziak DE, Ung YC, Yu E. Surgical, Radiation, and Systemic Treatments of Patients With Thymic Epithelial Tumors: A Systematic Review. J Thorac Oncol 2023; 18:299-312. [PMID: 36343922 DOI: 10.1016/j.jtho.2022.10.016] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2022] [Revised: 09/14/2022] [Accepted: 10/20/2022] [Indexed: 11/06/2022]
Abstract
INTRODUCTION Thymic epithelial tumors are rare and are classified as thymoma, thymic carcinoma, and thymic neuroendocrine tumors. The objective of this systematic review was to evaluate the treatment options for patients with thymic epithelial tumors. METHODS This systematic review was developed by Ontario Health (Cancer Care Ontario)'s Program in Evidence-Based Care and by the Lung Cancer Disease Site Group. MEDLINE, EMBASE, and the Cochrane Library were searched for studies comparing surgical, radiotherapy, or systemic treatments against any combination of these treatments in patients with thymic epithelial tumors. Meta-analyses were conducted with clinically homogenous studies. RESULTS A total of 106 studies were included, mainly from observational studies. There was an overall survival benefit with postoperative radiotherapy for patients with thymic carcinoma (hazard ratio = 0.65, 95% confidence interval: 0.47-0.89) and for patients with thymoma (hazard ratio = 0.70, 95% confidence interval: 0.59-0.82), especially for those with a high risk for mortality. Patients with thymic carcinoma or thymoma had a response to chemotherapy. Selection bias affected the results for studies that evaluated neoadjuvant chemotherapy or minimally invasive surgical techniques. Furthermore, the overall survival benefit found for adjuvant chemotherapy may have been confounded by the administration of postoperative radiotherapy. CONCLUSIONS For patients with thymoma or thymic carcinoma, the literature is of low quality and subject to bias. There were overall survival benefits with postoperative radiotherapy. The results of this systematic review were used to inform treatment recommendations in a clinical practice guideline. Future large-scale prospective studies that control for confounders are needed.
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Affiliation(s)
- Conrad B Falkson
- Radiation Oncology, Cancer Centre of Southeastern Ontario, Kingston General Hospital and Queen's University, Kingston, Ontario, Canada
| | - Emily T Vella
- Program in Evidence-Based Care, McMaster University, Hamilton, Ontario, Canada.
| | - Peter M Ellis
- Medical Oncology, Juravinski Cancer Centre and Department of Oncology, McMaster University, Hamilton, Ontario, Canada
| | - Donna E Maziak
- Thoracic Surgery, The Ottawa Hospital and University of Ottawa, Ottawa, Ontario, Canada
| | - Yee C Ung
- Radiation Oncology, Sunnybrook Odette Cancer Centre, Toronto, Ontario, Canada
| | - Edward Yu
- Radiation Oncology, London Regional Cancer Centre and Western University, London, Ontario, Canada
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5
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Current and Future Issues in the Surgical Treatment of Thymic Epithelial Tumors: a Review. Indian J Surg 2023. [DOI: 10.1007/s12262-023-03716-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/24/2023] Open
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6
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Kas J, Bogyó L, Fehér C, Ghimessy Á, Gieszer B, Karskó L, Kecskés L, Lungu V, Mészáros L, Pataki Á, Radetzky P, Szegedi R, Tallósy B, Török K, Vágvölgyi A, Fillinger J, Harkó T, Soltész I, Tóth E, Rózsa C, Elek J, Ganovszky E, Agócs L, Rényi-Vámos F, Kocsis Á. Unilateral video-assisted thoracoscopic thymoma resection – Indications, early and mid-term results. Magy Seb 2022; 75:79-95. [PMID: 35895535 DOI: 10.1556/1046.2022.20001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2021] [Accepted: 01/21/2022] [Indexed: 11/19/2022]
Abstract
Introduction. Thymoma is the most common tumour of the anterior mediastinum. Video-Assisted Thoracic Surgery technique of thymoma resection is spreading world-wide, but the thoracoscopic method is still contentious in many ways. Authors evaluate the early and mid-term results of a 17 years period of VATS unilateral approach at 2 Hungarian thoracic surgical centers. Method. Depending on the anatomical situation of the thymoma, we performed thymectomy, or partial thymectomy (thymomectomy) for the Masaoka–Koga I–II–III stage thymoma from the right or left side through 2 or 3 intercostal ports. We managed the operations with ultrasonic dissector and electrocauter. By using international standards we evaluated perioperative morbidity, mid-term oncological results and clinical symptoms of myasthenia. Results. 23 of the 54 patients were man, 31 were woman, the average age was 58 (26–79) years, 23 of them had myasthenia. The conversion rate was 11,5% (7/61). The average operation time was 84 (39–150) minutes. The average hospitalisation time was 5.5 (3–19) days. The average size of the thymomas was 46 (18–90) mm. The histology resulted thymoma type A in 2 cases, AB in 19 cases, B1/2/3 in 11/11/1 cases, mixed B in 10 cases. The examination of the resection line was R0/1/2 in 42/11/1 cases. The Masaoka–Koga stages were: I (17), IIA (28), IIB (2), III (7). There was 25 thymomectomies, and 29 thymectomies. In seven cases there were extension of the operation to the pericardium (2), to the lung (2), to the phrenic nerve (6), and to innominate vein (1). The in-hospital mortality over 30 day was in 1 case (1.85%). The morbidity was 11/54 (20.4%). The average follow-up time was 62.56 (5–198) months. In the group with myasthenia the effectivity of the operation was 18/21 (85.7%), including complete remission of 5/21 (23.8%). Post-thymectomy myasthenia gravis developed in 2/31 cases (6.5%). The average 5 years survival was 100%, tumour-free 5 years survival was 96%. Conclusions. The higher proportion of the thymomectomy in the early results, higher conversion rate and lower R0 proportion might be in connection with the attitude of the surgeons, with the learning curve and with the limitations of the unilateral method. After a longer follow-up time late results may become more real and comparable. Instead of unilateral VATS technique we have changed to the subxyphoideal approach of VATS because of its better visualisation.
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Affiliation(s)
- József Kas
- 1 Országos Korányi Pulmonológiai Intézet (főigazgató: dr. Bogos Krisztina), SE ÁOK Mellkassebészeti Klinika, Mellkassebészeti Központ, Budapest, Magyarország (központvezető: dr. Rényi-Vámos Ferenc, osztályvezető: dr. Kocsis Ákos)
| | - Levente Bogyó
- 2 Országos Onkológiai Intézet (főigazgató: dr. Polgár Csaba) Mellkasi Központ, Budapest, Magyarország (központ- és osztályvezető: dr. Rényi-Vámos Ferenc)
| | - Csaba Fehér
- 1 Országos Korányi Pulmonológiai Intézet (főigazgató: dr. Bogos Krisztina), SE ÁOK Mellkassebészeti Klinika, Mellkassebészeti Központ, Budapest, Magyarország (központvezető: dr. Rényi-Vámos Ferenc, osztályvezető: dr. Kocsis Ákos)
| | - Áron Ghimessy
- 2 Országos Onkológiai Intézet (főigazgató: dr. Polgár Csaba) Mellkasi Központ, Budapest, Magyarország (központ- és osztályvezető: dr. Rényi-Vámos Ferenc)
| | - Balázs Gieszer
- 2 Országos Onkológiai Intézet (főigazgató: dr. Polgár Csaba) Mellkasi Központ, Budapest, Magyarország (központ- és osztályvezető: dr. Rényi-Vámos Ferenc)
| | - Luca Karskó
- 1 Országos Korányi Pulmonológiai Intézet (főigazgató: dr. Bogos Krisztina), SE ÁOK Mellkassebészeti Klinika, Mellkassebészeti Központ, Budapest, Magyarország (központvezető: dr. Rényi-Vámos Ferenc, osztályvezető: dr. Kocsis Ákos)
| | - Lóránt Kecskés
- 1 Országos Korányi Pulmonológiai Intézet (főigazgató: dr. Bogos Krisztina), SE ÁOK Mellkassebészeti Klinika, Mellkassebészeti Központ, Budapest, Magyarország (központvezető: dr. Rényi-Vámos Ferenc, osztályvezető: dr. Kocsis Ákos)
| | - Viktor Lungu
- 1 Országos Korányi Pulmonológiai Intézet (főigazgató: dr. Bogos Krisztina), SE ÁOK Mellkassebészeti Klinika, Mellkassebészeti Központ, Budapest, Magyarország (központvezető: dr. Rényi-Vámos Ferenc, osztályvezető: dr. Kocsis Ákos)
| | - László Mészáros
- 2 Országos Onkológiai Intézet (főigazgató: dr. Polgár Csaba) Mellkasi Központ, Budapest, Magyarország (központ- és osztályvezető: dr. Rényi-Vámos Ferenc)
| | - Ágoston Pataki
- 1 Országos Korányi Pulmonológiai Intézet (főigazgató: dr. Bogos Krisztina), SE ÁOK Mellkassebészeti Klinika, Mellkassebészeti Központ, Budapest, Magyarország (központvezető: dr. Rényi-Vámos Ferenc, osztályvezető: dr. Kocsis Ákos)
| | - Péter Radetzky
- 2 Országos Onkológiai Intézet (főigazgató: dr. Polgár Csaba) Mellkasi Központ, Budapest, Magyarország (központ- és osztályvezető: dr. Rényi-Vámos Ferenc)
| | - Róbert Szegedi
- 1 Országos Korányi Pulmonológiai Intézet (főigazgató: dr. Bogos Krisztina), SE ÁOK Mellkassebészeti Klinika, Mellkassebészeti Központ, Budapest, Magyarország (központvezető: dr. Rényi-Vámos Ferenc, osztályvezető: dr. Kocsis Ákos)
| | - Bernadett Tallósy
- 2 Országos Onkológiai Intézet (főigazgató: dr. Polgár Csaba) Mellkasi Központ, Budapest, Magyarország (központ- és osztályvezető: dr. Rényi-Vámos Ferenc)
| | - Klári Török
- 2 Országos Onkológiai Intézet (főigazgató: dr. Polgár Csaba) Mellkasi Központ, Budapest, Magyarország (központ- és osztályvezető: dr. Rényi-Vámos Ferenc)
| | - Attila Vágvölgyi
- 1 Országos Korányi Pulmonológiai Intézet (főigazgató: dr. Bogos Krisztina), SE ÁOK Mellkassebészeti Klinika, Mellkassebészeti Központ, Budapest, Magyarország (központvezető: dr. Rényi-Vámos Ferenc, osztályvezető: dr. Kocsis Ákos)
| | - János Fillinger
- 3 Országos Korányi Pulmonológiai Intézet, Patológia, Budapest, Magyarország (osztályvezető: dr. Fillinger János)
| | - Tünde Harkó
- 3 Országos Korányi Pulmonológiai Intézet, Patológia, Budapest, Magyarország (osztályvezető: dr. Fillinger János)
| | - Ibolya Soltész
- 3 Országos Korányi Pulmonológiai Intézet, Patológia, Budapest, Magyarország (osztályvezető: dr. Fillinger János)
| | - Erika Tóth
- 4 Országos Onkológiai Intézet, Daganatpatológiai Központ (központvezető: dr. Szőke János, osztályvezető: dr. Tóth Erika)
| | - Csilla Rózsa
- 5 Jahn Ferenc Dél-pesti Kórház és Rendelőintézet, Budapest, Magyarország (főigazgató: dr. Ralovich Zsolt), Neurológia (osztályvezető: dr. Rózsa Csilla)
| | - Jenő Elek
- 6 Országos Korányi Pulmonológiai Intézet, AITO, Budapest, Magyarország (osztályvezető: dr. Elek Jenő).,7 Országos Onkológiai Intézet, AITO, Budapest, Magyarország (osztályvezető: dr. Elek Jenő)
| | - Erna Ganovszky
- 8 Országos Onkológiai Intézet, Gyógyszerterápiás Központ, Budapest, Magyarország (központvezető: dr. Géczi Lajos, osztályvezető: dr. Rubovszky Gábor László)
| | - László Agócs
- 1 Országos Korányi Pulmonológiai Intézet (főigazgató: dr. Bogos Krisztina), SE ÁOK Mellkassebészeti Klinika, Mellkassebészeti Központ, Budapest, Magyarország (központvezető: dr. Rényi-Vámos Ferenc, osztályvezető: dr. Kocsis Ákos).,2 Országos Onkológiai Intézet (főigazgató: dr. Polgár Csaba) Mellkasi Központ, Budapest, Magyarország (központ- és osztályvezető: dr. Rényi-Vámos Ferenc)
| | - Ferenc Rényi-Vámos
- 1 Országos Korányi Pulmonológiai Intézet (főigazgató: dr. Bogos Krisztina), SE ÁOK Mellkassebészeti Klinika, Mellkassebészeti Központ, Budapest, Magyarország (központvezető: dr. Rényi-Vámos Ferenc, osztályvezető: dr. Kocsis Ákos).,2 Országos Onkológiai Intézet (főigazgató: dr. Polgár Csaba) Mellkasi Központ, Budapest, Magyarország (központ- és osztályvezető: dr. Rényi-Vámos Ferenc)
| | - Ákos Kocsis
- 1 Országos Korányi Pulmonológiai Intézet (főigazgató: dr. Bogos Krisztina), SE ÁOK Mellkassebészeti Klinika, Mellkassebészeti Központ, Budapest, Magyarország (központvezető: dr. Rényi-Vámos Ferenc, osztályvezető: dr. Kocsis Ákos).,2 Országos Onkológiai Intézet (főigazgató: dr. Polgár Csaba) Mellkasi Központ, Budapest, Magyarország (központ- és osztályvezető: dr. Rényi-Vámos Ferenc)
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Voulaz E, Perroni G, Russo A, Patirelis A, Mangiameli G, Alloisio M, Ambrogi V. Thymomectomy versus complete thymectomy in early-stage non-myasthenic thymomas: a multicentric propensity score-matched study. Interact Cardiovasc Thorac Surg 2022; 35:6611721. [PMID: 35723542 PMCID: PMC9240760 DOI: 10.1093/icvts/ivac167] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Revised: 06/03/2022] [Accepted: 06/15/2022] [Indexed: 11/14/2022] Open
Affiliation(s)
- Emanuele Voulaz
- IRCCS Humanitas Research Hospital, Department of Thoracic Surgery , Milan, Italy
- Department of Biomedical Sciences, Humanitas University , Milan, Italy
| | - Gianluca Perroni
- Division of Thoracic Surgery, Department of Thoracic Surgery, Tor Vergata University Polyclinic , Rome, Italy
| | - Anna Russo
- Division of Thoracic Surgery, Department of Thoracic Surgery, Tor Vergata University Polyclinic , Rome, Italy
| | - Alexandro Patirelis
- Division of Thoracic Surgery, Department of Thoracic Surgery, Tor Vergata University Polyclinic , Rome, Italy
| | - Giuseppe Mangiameli
- IRCCS Humanitas Research Hospital, Department of Thoracic Surgery , Milan, Italy
- Department of Biomedical Sciences, Humanitas University , Milan, Italy
| | - Marco Alloisio
- IRCCS Humanitas Research Hospital, Department of Thoracic Surgery , Milan, Italy
- Department of Biomedical Sciences, Humanitas University , Milan, Italy
| | - Vincenzo Ambrogi
- Division of Thoracic Surgery, Department of Thoracic Surgery, Tor Vergata University Polyclinic , Rome, Italy
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Patel G, Reddy BVK, Patil P. Maximal Thymectomy via Mini Sternotomy with Pleural Preservation. South Asian J Cancer 2022; 11:229-234. [PMID: 36620502 PMCID: PMC9822780 DOI: 10.1055/s-0042-1743162] [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] [Indexed: 01/11/2023] Open
Abstract
Gaurav PatelBackground There are different surgical techniques used for maximal thymectomy. Each technique has its own advantages and disadvantages. We propose a mini sternotomy with pleural preservation approach for complete maximal thymectomy. Methods Over time range of 5 years, 32 patients with diagnosis of thymoma with or without myasthenia gravis (MG) underwent maximal thymectomy by mini sternotomy in our institute. Patient records were examined for the following parameters: age, sex, preoperative medication, symptoms of MG as per Myasthenia Gravis Foundation of America grading system, operating time, duration of postoperative ventilation, length of stay in the intensive care unit, overall length of hospitalization, and postoperative complications. Results The mean age of patients in our study was 43.66. Sex ratio in this study was almost equal. Sixty-nine percent of patients were stage I thymoma according to Masaoka staging. Size of the tumor ranged from 3 to 8 cm with mean size being 4.54 cm. Complete resection with negative tumor margins was possible in all the cases. Four patients had intraoperative pleural injury out of which two patients required intercostal tube insertion. We did not have any serious postoperative complications with no perioperative mortality. Conclusions Mini sternotomy allows maximal removal of thymus through a less invasive approach and is associated with a significantly smoother postoperative course, less overall complications, and good clinical outcome. It is a simple technique that can be performed by any thoracic and surgical oncologists especially in Indian subcontinent where facilities of video-assisted thoracoscopic surgery and robotic video-assisted thoracoscopic surgery are not available in all areas and are expensive.
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Affiliation(s)
- Gaurav Patel
- Department of Surgical Oncology, Bombay Hospital and Medical Research Centre, Marine Lines, Mumbai, Maharashtra, India,Address for correspondence Gaurav Patel, MBBS, MS Department of Surgical Oncology, Bombay Hospital and Medical Research CentreMumbai-400020, MaharashtraIndia
| | - Bojja V. Kishore Reddy
- Department of Surgical Oncology, Bombay Hospital and Medical Research Centre, Marine Lines, Mumbai, Maharashtra, India
| | - Prakash Patil
- Department of Surgical Oncology, Bombay Hospital and Medical Research Centre, Marine Lines, Mumbai, Maharashtra, India
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9
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Guerrera F, Falcoz PE, Moser B, van Raemdonck D, Bille' A, Toker A, Spaggiari L, Ampollini L, Filippini C, Thomas PA, Verdonck B, Mendogni P, Aigner C, Voltolini L, Novoa N, Patella M, Mantovani S, Bravio IG, Zisis C, Guirao A, Londero F, Congregado M, Rocco G, Du Pont B, Martucci N, Esch M, Brunelli A, Detterbeck FC, Venuta F, Weder W, Ruffini E, Klepetko W, Olland A, Du Pont B, Nonaka D, Ozkan B, Lo Iacono G, Braggio C, Filosso PL, Brioude G, van Schil P, Nosotti M, Valdivia D, Bongiolatti S, Inci I, Dimitra R, Sànchez D, Grossi W, Moreno-Merino S, Teschner M. Thymomectomy plus total thymectomy versus simple thymomectomy for early-stage thymoma without myasthenia gravis: a European Society of Thoracic Surgeons Thymic Working Group Study. Eur J Cardiothorac Surg 2021; 60:881-887. [PMID: 34023891 DOI: 10.1093/ejcts/ezab224] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2020] [Revised: 03/17/2021] [Accepted: 03/19/2021] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES Resection of thymic tumours including the removal of both the tumour and the thymus gland (thymothymectomy; TT) is the procedure of choice and is recommended in most relevant articles in the literature. Nevertheless, in recent years, some authors have suggested that resection of the tumour (simple thymomectomy; ST) may suffice from an oncological standpoint in patients with early-stage thymoma who do not have myasthenia gravis (MG) (non-MG). The goal of our study was to compare the short- and long-term outcomes of ST versus TT in non-MG early-stage thymomas using the European Society of Thoracic Surgeons thymic database. METHODS A total of 498 non-MG patients with pathological stage I thymoma were included in the study. TT was performed in 466 (93.6%) of 498 patients who had surgery with curative intent; ST was done in 32 (6.4%). The completeness of resection, the rate of complications, the 30-day mortality, the overall recurrence and the freedom from recurrence were compared. We performed crude and propensity score-adjusted comparisons by surgical approach (ST vs TT). RESULTS TT showed the same rate of postoperative complications, 30-day mortality and postoperative length of stay as ST. The 5-year overall survival rate was 89% in the TT group and 55% in the ST group. The 5-year freedom from recurrence was 96% in the TT group and 79% in the ST group. CONCLUSION Patients with early-stage thymoma without MG who have a TT show significantly better freedom from recurrence than those who have an ST, without an increase in postoperative morbidity rate.
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Affiliation(s)
- Francesco Guerrera
- Department of Thoracic Surgery, Azienda Ospedaliera Universitaria Città della Salute e Della Scienza di Torino, Torino, Italy.,Department of Surgical Sciences, University of Torino, Torino, Italy
| | | | - Bernhard Moser
- Department of Thoracic Surgery, Vienna University Hospital, Vienna, Austria
| | - Dirk van Raemdonck
- Department of Thoracic Surgery, University Hospitals Leuven, Leuven, Belgium.,Department of Chronic Diseases and Metabolism, Katholieke Universiteit Leuven, Leuven, Belgium
| | - Andrea Bille'
- Department of Thoracic Surgery, Guy's Hospital London, London, UK.,Division of Cancer Studies, King's College London, Guy's Hospital London, London, UK
| | - Alper Toker
- Department of Cardiovascular and Thoracic Surgery, West Virginia University Heart and Vascular Institute, Morgantown, WV, USA
| | - Lorenzo Spaggiari
- Division of Thoracic Surgery, European Institute of Oncology, IRCCS, Milano, Italy.,Department of Oncology and Hemato-oncology, University of Milan, Milano, Italy
| | - Luca Ampollini
- Thoracic Surgery, Department of Medicine and Surgery, University Hospital of Parma, Milano, Italy
| | - Claudia Filippini
- Department of Surgical Sciences, University of Torino, Torino, Italy
| | | | - Bram Verdonck
- Department of Thoracic and Vascular Surgery, Antwerp University Hospital and Antwerp University, Antwerp, Belgium
| | - Paolo Mendogni
- Department of Thoracic Surgery, Foundation IRCCS Cà Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Clemens Aigner
- Department of Thoracic Surgery, Essen University Hospital - Ruhrlandklinik, Essen, Germany
| | - Luca Voltolini
- Department of Thoracic Surgery, Careggi University Hospital, Firenze, Italy
| | - Nuria Novoa
- Thoracic Surgery Service, Salamanca University Hospital and School of Medicine, Salamanca, Spain
| | - Miriam Patella
- Department of Thoracic Surgery, Zurich University Hospital, Zurich, Switzerland
| | - Sara Mantovani
- Division of Thoracic Surgery and Lung Transplant, Sapienza University of Rome and AOU Policlinico Umberto I, Roma, Italy
| | - Ivan Gomes Bravio
- Department of Thoracic Surgery, Francisco Gentil Portuguese Institute of Oncology CUF Infante Santo Hospital, Lisboa, Portugal
| | - Charalambos Zisis
- Department of Thoracic Surgery, Athens Evangelismos Hospital, Athens, Greece
| | - Angela Guirao
- Department of Thoracic Surgery, Hospital Clínic, Universitat de Barcelona, Barcelona, Spain
| | - Francesco Londero
- Thoracic Surgery Unit-Cardiothoracic Department, Azienda Sanitaria Universitaria Integrata S Maria della Misericordia, Udine, Italy
| | - Miguel Congregado
- General Thoracic Surgery Department, Virgen Macarena University Hospital and University of Seville, Seville, Spain
| | - Gaetano Rocco
- Thoracic Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Bert Du Pont
- Department of Thoracic Surgery, University Hospitals Leuven, Leuven, Belgium.,Department of Chronic Diseases and Metabolism, Katholieke Universiteit Leuven, Leuven, Belgium
| | - Nicola Martucci
- Division of Thoracic Surgery, Department of Thoracic Surgery and Oncology, Istituto Nazionale Tumori - IRCCS - Fondazione "G. Pascale", Naples, Italy
| | - Matthias Esch
- Department of Thoracic Surgery, Josef Hospital Delmenhorst, Delmenhorst, Germany
| | | | - Frank C Detterbeck
- Section of Thoracic Surgery, Department of Surgery, Yale Thoracic Oncology Program, Yale University School of Medicine, New Haven, CT, USA
| | - Federico Venuta
- Division of Thoracic Surgery and Lung Transplant, Sapienza University of Rome and AOU Policlinico Umberto I, Roma, Italy
| | - Walter Weder
- Department of Thoracic Surgery, Zurich University Hospital, Zurich, Switzerland
| | - Enrico Ruffini
- Department of Surgical Sciences, University of Torino, Torino, Italy.,Department of Surgical Sciences, Strasbourg University Hospital, Strasbourg, France
| | | | - Walter Klepetko
- Department of Thoracic Surgery, Vienna University Hospital, Vienna, Austria
| | - Anne Olland
- Department of Surgical Sciences, Strasbourg University Hospital, Strasbourg, France
| | - Bert Du Pont
- Department of Thoracic Surgery, University Hospitals Leuven, Leuven, Belgium.,Department of Chronic Diseases and Metabolism, Katholieke Universiteit Leuven, Leuven, Belgium
| | - Daisuke Nonaka
- Section of Thoracic Surgery, Department of Surgery, Yale Thoracic Oncology Program, Yale University School of Medicine, New Haven, CT, USA
| | - Berker Ozkan
- Department of Pathology, Guy's Hospital London, London, UK
| | - Giorgio Lo Iacono
- Division of Thoracic Surgery, European Institute of Oncology, IRCCS, Milano, Italy
| | - Cesare Braggio
- Thoracic Surgery, Department of Medicine and Surgery, University Hospital of Parma, Milano, Italy
| | - Pier Luigi Filosso
- Department of Surgical Sciences, University of Torino, Torino, Italy.,Department of Surgical Sciences, Strasbourg University Hospital, Strasbourg, France
| | - Geoffrey Brioude
- Department of Thoracic Surgery, North Hospital Aix-Marseille University, Marseille, France
| | - Paul van Schil
- Department of Thoracic and Vascular Surgery, Antwerp University Hospital and Antwerp University, Antwerp, Belgium
| | - Mario Nosotti
- Department of Thoracic Surgery, Foundation IRCCS Cà Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Daniel Valdivia
- Department of Thoracic Surgery, Essen University Hospital - Ruhrlandklinik, Essen, Germany
| | | | - Ilhan Inci
- Department of Thoracic Surgery, Zurich University Hospital, Zurich, Switzerland
| | - Rontogianni Dimitra
- Department of Thoracic Surgery, Istanbul Medical School, Turkey.,Department of Pathology, Athens Evangelismos Hospital, Greece
| | - David Sànchez
- Department of Thoracic Surgery, Hospital Clínic, Universitat de Barcelona, Barcelona, Spain
| | - William Grossi
- Thoracic Surgery Unit-Cardiothoracic Department, Azienda Sanitaria Universitaria Integrata S Maria della Misericordia, Udine, Italy
| | - Sergio Moreno-Merino
- General Thoracic Surgery Department, Virgen Macarena University Hospital and University of Seville, Seville, Spain
| | - Martin Teschner
- Department of Thoracic Surgery, Athens Evangelismos Hospital, Athens, Greece
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10
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Papadimas E, Tan YK, Luo H, Choong AMTL, Tam JKC, Kofidis T, Mithiran H. Partial Versus Complete Thymectomy in Non-Myasthenic Patients With Thymoma: A Systematic Review and Meta-Analysis of Clinical Outcomes. Heart Lung Circ 2021; 31:59-68. [PMID: 34509374 DOI: 10.1016/j.hlc.2021.08.003] [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] [Received: 10/22/2020] [Revised: 06/20/2021] [Accepted: 08/08/2021] [Indexed: 11/20/2022]
Abstract
The optimal extent of surgical resection for non-myasthenic patients with thymoma is controversial. The objective of this meta-analysis was to compare complete to partial thymectomy in non-myasthenic patients for oncological and postoperative clinical outcomes. We performed a PubMed and EMBASE search (from inception to January 2020) for English-language studies directly comparing partial to complete thymectomy for thymoma resection. Clinical endpoints studied included overall and disease-free survival, Masaoka and World Health Organization staging, adjuvant therapy, postoperative complications, postoperative drainage, length of hospital stay, thymoma-related deaths, postresection development of myasthenia gravis, incomplete resection, and recurrence. Random effects meta-analyses across all clinical endpoints was done. There was no statistically significant difference between the two approaches with regard to recurrence (odds ratio [OR], 1.22; 95% confidence interval [CI], 0.78-1.92), completeness of resection (OR, 1.17; 95% CI, 0.66-2.10), adjuvant therapy (OR, 0.71; 95% CI, 0.40-1.26), or thymoma-related deaths (OR, 0.76; 95% CI, 0.12-4.66). There was a statistically significant decrease in postoperative complications (OR, 0.61; 95% CI, 0.39-0.97), drainage (mean difference [MD], -0.99; 95% CI, -1.98 to -0.01), and length of hospital length (MD, -1.88; 95% CI, -3.39 to -0.36) with partial thymectomy. The evidence appeared to suggest that partial thymectomy is oncologically equivalent to complete thymectomy for non-myasthenic patients with early-stage thymoma. There is an additional advantage of reduced postoperative complications and decreased length of hospital stay with partial thymectomy.
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Affiliation(s)
- Evangelos Papadimas
- Department of Cardiac Thoracic and Vascular Surgery, National University Heart Centre, Singapore.
| | | | - HaiDong Luo
- Department of Cardiac Thoracic and Vascular Surgery, National University Heart Centre, Singapore
| | - Andrew M T L Choong
- Department of Cardiac Thoracic and Vascular Surgery, National University Heart Centre, Singapore; Cardiovascular Research Institute, National University of Singapore, Singapore; Department of Surgery, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - John K C Tam
- Department of Cardiac Thoracic and Vascular Surgery, National University Heart Centre, Singapore
| | - Theo Kofidis
- Department of Cardiac Thoracic and Vascular Surgery, National University Heart Centre, Singapore
| | - Harish Mithiran
- Department of Cardiac Thoracic and Vascular Surgery, National University Heart Centre, Singapore
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11
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Nakagawa K, Asamura H. Limited resection for early-stage thymoma: minimally invasive resection does not mean limited resection. Jpn J Clin Oncol 2021; 51:1197-1203. [PMID: 34212196 DOI: 10.1093/jjco/hyab102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Accepted: 06/16/2021] [Indexed: 11/15/2022] Open
Abstract
Standard resection for patients with thymoma is resection of thymoma with total thymectomy (TTx) via median sternotomy. Hence, limited resection for thymoma means a lesser extent of resection of normal thymus compared with a standard procedure, i.e. resection of thymoma with partial thymectomy (PTx). In contrast, minimally invasive resection has been defined as resection of thymoma with TTx via a less-invasive approach. However, to date, few studies have precisely evaluated the differences in surgical and oncological outcomes among these three procedures. This report summarizes the differences among these three procedures with a review of studies (January 2000 to December 2020) focusing on the difference in surgical and oncological outcomes and presents current issues in the surgical management of thymoma. In this report, 16 studies were identified; 5 compared standard resection to limited resection, 9 compared standard resection to minimally invasive resection and 2 compared limited resection to minimally invasive resection. Most studies reported that the surgical and oncological outcomes of limited resection or minimally invasive resection were similar to those of standard resection in patients with early-stage thymoma. However, they did not include a sufficient follow-up period. Both limited resection and minimally invasive resection for early-stage thymoma might be reasonable treatment options. However, they are still promising modes of resection. Further studies with a long follow-up period are needed.
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Affiliation(s)
- Kazuo Nakagawa
- Department of Thoracic Surgery, National Cancer Center Hospital, Tokyo, Japan
| | - Hisao Asamura
- Division of Thoracic Surgery, Keio University School of Medicine, Tokyo, Japan
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12
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Lucchi M, Aprile V. Surgery for thymomas: is less worthwhile? A clear answer from the European experience. Eur J Cardiothorac Surg 2021; 60:888-889. [PMID: 34165529 DOI: 10.1093/ejcts/ezab293] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Affiliation(s)
- Marco Lucchi
- Division of Thoracic Surgery, Department of Surgical, Medical and Molecular Pathology and Critical Care Medicine, University of Pisa, Pisa, Italy
| | - Vittorio Aprile
- Division of Thoracic Surgery, Department of Surgical, Medical and Molecular Pathology and Critical Care Medicine, University of Pisa, Pisa, Italy
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13
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Pulle MV, Asaf BB, Puri HV, Bishnoi S, Kumar A. Meta-Analysis of Limited Thymectomy versus Total Thymectomy for Masaoka Stage I and II Thymoma. J Chest Surg 2021; 54:127-136. [PMID: 33767014 PMCID: PMC8038883 DOI: 10.5090/jcs.20.140] [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: 10/26/2020] [Revised: 11/23/2020] [Accepted: 12/03/2020] [Indexed: 11/16/2022] Open
Abstract
Background This meta-analysis aimed to evaluate the incidence of tumor recurrence, postoperative myasthenia gravis, postoperative complications, and overall survival after limited versus total thymectomy for Masaoka stage I and II thymoma. Methods A systematic search of the literature was conducted using the PubMed, Embase, MEDLINE, and Cochrane databases to identify relevant studies that compared limited and total thymectomy in Masaoka stage I-II patients. The quality of the included observational studies was assessed using the Newcastle-Ottawa Scale. The results of the meta- analysis were expressed as log-transformed odds ratios (log ORs), with 95% confidence intervals (CIs). Results Seven observational studies with a total of 2,310 patients were included in the meta-analysis. There was an overall non-significant difference in favor of total thymectomy in terms of tumor recurrence (pooled log OR, 0.40; 95% CI, -0.07 to 0.87; p=0.10; I2=0%) and postoperative myasthenia gravis (pooled log OR, 0.12; 95% CI, -1.08 to 1.32; p=0.85; I2=22.6%). However, an overall non-significant difference was found in favor of limited thymectomy with respect to postoperative complications (pooled log OR, -0.21; 95% CI, -1.08 to 0.66; p=0.64; I2=36.1%) and overall survival (pooled log OR, -0.01; 95% CI, -0.68 to 0.66; p=0.98; I2=47.8%). Conclusion Based on the results of this systematic review and meta-analysis, limited thymectomy as a treatment for stage I and II thymoma shows similar oncologic outcomes to total thymectomy.
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Affiliation(s)
| | - Belal Bin Asaf
- Centre for Chest Surgery, Sir Ganga Ram Hospital, New Delhi, India
| | | | - Sukhram Bishnoi
- Centre for Chest Surgery, Sir Ganga Ram Hospital, New Delhi, India
| | - Arvind Kumar
- Centre for Chest Surgery, Sir Ganga Ram Hospital, New Delhi, India
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14
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Abstract
Resection is the mainstay of treatment for thymic epithelial tumors (TETs), with complete removal of the tumor and involved organs being the ultimate aim. The choice of surgical approach plays a major role in defining treatment success, and the optimal choice of method should thus provide an adequate surgical view to achieve complete tumor resection. While median sternotomy is considered the gold standard for access to the mediastinum, several minimally invasive approaches to thymectomy have been described, including video-assisted robotic-assisted thymectomy, although the oncological outcomes of that procedure remain unclear. A multimodal approach incorporating chemotherapy or chemoradiotherapy followed by extended surgery may improve resectability and outcomes for patients with advanced TETs. Surgical debulking is also reportedly acceptable for invasive thymoma because of its potential for achieving favorable outcomes. Re-resection is an acceptable option for patients with recurrent thymoma after initial resection, and repeat resection for recurrent pleural dissemination seems effective. Here, the literature on current clinical practices in the surgical management and treatment of TETs is reviewed.
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15
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Yang L, Cai W, Yang X, Zhu H, Liu Z, Wu X, Lei Y, Zou J, Zeng B, Tian X, Zhang R, Luo H, Zhu Y. Development of a deep learning model for classifying thymoma as Masaoka-Koga stage I or II via preoperative CT images. ANNALS OF TRANSLATIONAL MEDICINE 2020; 8:287. [PMID: 32355731 PMCID: PMC7186715 DOI: 10.21037/atm.2020.02.183] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Background Accurate thymoma staging via computed tomography (CT) images is difficult even for experienced thoracic doctors. Here we developed a preoperative staging tool differentiating Masaoka-Koga (MK) stage I patients from stage II patients using CT images. Methods CT images of 174 thymoma patients were retrospectively selected. Two chest radiologists independently assessed the images. Variables with statistical differences in univariate analysis were adjusted for age, sex, and smoking history in multivariate logical regression to determine independent predictors of the thymoma stage. We established a deep learning (DL) 3D-DenseNet model to distinguish the MK stage I and stage II thymomas. Furthermore, we compared two different methods to label the regions of interest (ROI) in CT images. Results In routine CT images, there were statistical differences (P<0.05) in contour, necrosis, cystic components, and the degree of enhancement between stage I and II disease. Multivariate logical regression showed that only the degree of enhancement was an independent predictor of the thymoma stage. The area under the receiver operating characteristic curve (AUC) of routine CT images for classifying thymoma as MK stage I or II was low (AUC =0.639). The AUC of the 3D-DenseNet model showed better performance with a higher AUC (0.773). ROIs outlined by segmentation labels performed better (AUC =0.773) than those outlined by bounding box labels (AUC =0.722). Conclusions Our DL 3D-DenseNet may aid thymoma stage classification, which may ultimately guide surgical treatment and improve outcomes. Compared with conventional methods, this approach provides improved staging accuracy. Moreover, ROIs labeled by segmentation is more recommendable when the sample size is limited.
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Affiliation(s)
- Lei Yang
- Department of Thoracic Surgery, the First Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong 510080, China
| | - Wenjia Cai
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou 510060, China
| | - Xiaoyu Yang
- Department of Radiology, the First Affiliated Hospital of Sun Yat-sen University, Guangzhou 510080, China
| | - Haoshuai Zhu
- Department of Thoracic Surgery, the First Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong 510080, China
| | - Zhenguo Liu
- Department of Thoracic Surgery, the First Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong 510080, China
| | - Xi Wu
- Department of Radiology, the First Affiliated Hospital of Sun Yat-sen University, Guangzhou 510080, China
| | - Yiyan Lei
- Department of Thoracic Surgery, the First Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong 510080, China
| | - Jianyong Zou
- Department of Thoracic Surgery, the First Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong 510080, China
| | - Bo Zeng
- Department of Thoracic Surgery, the First Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong 510080, China
| | - Xi Tian
- Advanced Institute, Infervision, Beijing 100000, China
| | - Rongguo Zhang
- Advanced Institute, Infervision, Beijing 100000, China
| | - Honghe Luo
- Department of Thoracic Surgery, the First Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong 510080, China
| | - Ying Zhu
- Department of Radiology, the First Affiliated Hospital of Sun Yat-sen University, Guangzhou 510080, China
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16
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Chen K, Zhang X, Jin R, Xiang J, Han D, Zhang Y, Li H. Robot-assisted thoracoscopic surgery for mediastinal masses: a single-institution experience. J Thorac Dis 2020; 12:105-113. [PMID: 32190360 DOI: 10.21037/jtd.2019.08.105] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Background The objectives of this study were to evaluate the feasibility and safety of robot-assisted thoracic surgery (RATS) using the da Vinci robotic system for mediastinal mass resection and to describe the surgical approach for masses in different mediastinal regions. Methods We retrospectively reviewed data from 84 patients who underwent RATS for resection of a mediastinal mass from June 2015 to April 2019. The results were analyzed with descriptive statistics. Results The mediastinal mass was resected successfully in all patients, with one patient requiring conversion to conventional open surgery. There were no intraoperative complications. The most common diagnoses were thymoma (n=17), bronchogenic cyst (n=16), and schwannoma (n=12). The surgical approach was determined by the location of the lesion and the planned extent of surgical resection. Resection was performed in the lateral decubitus position in 29 patients with posterior mediastinal tumor, semi-lateral decubitus position in 42 patients who only need resection of anterior mediastinal mass, and reverse Trendelenburg position in 13 patients undergoing thymectomy. The mean (± standard deviation) operation time was 91.86±56.42 min, duration of chest tube use was 1.83±0.93 days, and postoperative hospital stay was 3.62±7.52 days. Three patients (3.5%) developed postoperative complications: one chylous fistula, which required reoperation, and one case each of atrial fibrillation and pulmonary infection, which were treated conservatively. Conclusions Our experience demonstrated that different surgical approaches of RATS are safe and feasible for mediastinal mass resection. An appropriate approach can be selected based on the mediastinal region in which the tumor is located.
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Affiliation(s)
- Kai Chen
- Department of Thoracic Surgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China
| | - Xianfei Zhang
- Department of Thoracic Surgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China
| | - Runsen Jin
- Department of Thoracic Surgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China
| | - Jie Xiang
- Department of Thoracic Surgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China
| | - Dingpei Han
- Department of Thoracic Surgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China
| | - Yajie Zhang
- Department of Thoracic Surgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China
| | - Hecheng Li
- Department of Thoracic Surgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China
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17
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Wang GW, Tao T, Li CK, Li QC, Duan GX, Sang HW, Dong HJ, Wang ZY. Comparison between thoracoscopic and open approaches in thymoma resection. J Thorac Dis 2019; 11:4159-4168. [PMID: 31737299 DOI: 10.21037/jtd.2019.09.85] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Background To investigate the feasibility and indications of video-assisted thoracic surgery (VATS) in thymoma resection. Methods The clinical data of 103 patients undergoing thymoma resection via different approaches [including conventional lateral thoracotomy approach (LTA) in 41 cases, median sternotomy approach (MSA) in 40 cases, and right-sided VATS in 22 cases] were analyzed. Among them, 59, 13, 25, and 6 patients were in Masaoka stage I, II, III, and IV, respectively. Myasthenia gravis (MG) was also found in 54 cases. The patients were followed up for postoperative survival and the improvement in MG. The prognostic indicators of patients undergoing thymoma resection via different surgical approaches (i.e., LTA, MSA, and VATS) were statistically analyzed. Results Eight of 103 patients died. Six patients underwent unilateral sacral nerve resection, among whom 4 patients developed respiratory dysfunction, and 3 died. Two patients died of MG after surgery, 1 patient died of tumor recurrence and metastasis, 1 patient died of heart disease, and the cause of death was unknown in the remaining patient. The drainage time was shorter in VATS group than in open groups, along with smaller tumor size. The VATS group also had shorter hospital stay in the whole series and the subgroup without accompanying MG. The improvement in MG showed no significant difference among the three surgical groups. Both 5- and 10-year survival rates were 91% in the entire cohort. Conclusions VATS is like a conventional surgeries for improving MG in thymoma patients with accompanying MG. VATS resection can still be considered for thymoma that only invades the mediastinal pleura. For thymomas that have intact capsules and have not invaded mediastinal pleura, MSA surgery shall be performed to ensure patient safety if the anteroposterior diameters of the tumors are large and the masses have produced severe compression of the innominate vein, even if the tumors are still in the Masaoka stage II. For thymomas with large left-to-right diameters and with most parts of the tumors located in the left thoracic cavity, a left-sided approach (either VATS or an open approach) may be used in the absence of MG; if MG accompanies the condition, an MT approach or a bilateral VATS may be considered. In patients with unilateral pericardial phrenic nerve and/or local pericardial involvement, right-sided VATS thymectomy may be considered for thymomas located at the right side and bilateral VATS surgery can be performed for tumors located at the left side. In summary, VATS is feasible for the treatment of thymoma complicated by MG. VATS can be performed in patients with Masaoka stage I, II and (a certain portion of) III thymoma; for some patients with Masaoka stage II thymoma, especially those with compression of the innominate vein, the use of VATS should be cautious.
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Affiliation(s)
- Guo-Wen Wang
- Department of Thoracic Surgery, the First Affiliated Hospital of Bengbu Medical College, Bengbu 233000, China
| | - Tao Tao
- Department of Thoracic Surgery, the First Affiliated Hospital of Bengbu Medical College, Bengbu 233000, China
| | - Chuan-Kui Li
- Department of Thoracic Surgery, the First Affiliated Hospital of Bengbu Medical College, Bengbu 233000, China
| | - Qi-Cai Li
- Department of Thoracic Surgery, the First Affiliated Hospital of Bengbu Medical College, Bengbu 233000, China
| | - Gui-Xin Duan
- Department of Thoracic Surgery, the First Affiliated Hospital of Bengbu Medical College, Bengbu 233000, China
| | - Hai-Wei Sang
- Department of Thoracic Surgery, the First Affiliated Hospital of Bengbu Medical College, Bengbu 233000, China
| | - Hai-Jun Dong
- Department of Thoracic Surgery, the First Affiliated Hospital of Bengbu Medical College, Bengbu 233000, China
| | - Zu-Yi Wang
- Department of Thoracic Surgery, the First Affiliated Hospital of Bengbu Medical College, Bengbu 233000, China
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Anile M, Poggi C, Diso D, Pecoraro Y, Rendina EA, Venuta F. Wind of change in surgical treatment of thymic tumors. J Thorac Dis 2018; 10:S3121-S3123. [PMID: 30370093 DOI: 10.21037/jtd.2018.07.134] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Affiliation(s)
- Marco Anile
- Department of Thoracic Surgery, University of Rome Sapienza, Roma, Italy
| | - Camilla Poggi
- Department of Thoracic Surgery, University of Rome Sapienza, Roma, Italy
| | - Daniele Diso
- Department of Thoracic Surgery, University of Rome Sapienza, Roma, Italy
| | - Ylenia Pecoraro
- Department of Thoracic Surgery, University of Rome Sapienza, Roma, Italy
| | - Erino A Rendina
- Department of Thoracic Surgery, University of Rome Sapienza, Roma, Italy
| | - Federico Venuta
- Department of Thoracic Surgery, University of Rome Sapienza, Roma, Italy
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Fiorelli A, Natale G, Freda C, Santini M. Is thymomectomy equivalent to complete thymectomy in non-myasthenic patients with early-stage thymoma? Interact Cardiovasc Thorac Surg 2018; 28:399-403. [DOI: 10.1093/icvts/ivy270] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2018] [Revised: 08/07/2018] [Accepted: 08/12/2018] [Indexed: 11/13/2022] Open
Affiliation(s)
- Alfonso Fiorelli
- Department of Translational Medicine, Thoracic Surgery Unit, Università della Campania “Luigi Vanvitelli”, Naples, Italy
| | - Giovanni Natale
- Department of Translational Medicine, Thoracic Surgery Unit, Università della Campania “Luigi Vanvitelli”, Naples, Italy
| | - Chiara Freda
- Department of Translational Medicine, Thoracic Surgery Unit, Università della Campania “Luigi Vanvitelli”, Naples, Italy
| | - Mario Santini
- Department of Translational Medicine, Thoracic Surgery Unit, Università della Campania “Luigi Vanvitelli”, Naples, Italy
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20
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Zhang X, Gu Z, Fang W. Minimally invasive surgery in thymic malignances: the new standard of care. J Thorac Dis 2018; 10:S1666-S1670. [PMID: 30034833 DOI: 10.21037/jtd.2018.05.168] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Surgery is the most important therapy for thymic malignancies. The last decade has seen increasing adoption of minimally invasive thymectomy (MIT) for thymic tumors. MIT for early stage diseases has been shown to yield similar oncological results while being helpful in minimizing surgical trauma, improving postoperative recovery, and reducing incisional pain. Similar surgical and oncological principles should be observed in both minimally invasive and open procedures so as to ensure radical resection and accurate staging of the tumor.
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Affiliation(s)
- Xuefei Zhang
- Department of Thoracic Surgery, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai 200030, China
| | - Zhitao Gu
- Department of Thoracic Surgery, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai 200030, China
| | - Wentao Fang
- Department of Thoracic Surgery, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai 200030, China
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21
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Fang W, Yao X, Antonicelli A, Gu Z, Detterbeck F, Vallières E, Aye RW, Farivar AS, Huang J, Shang Y, Louie BE. Comparison of surgical approach and extent of resection for Masaoka-Koga Stage I and II thymic tumours in Europe, North America and Asia: an International Thymic Malignancy Interest Group retrospective database analysis. Eur J Cardiothorac Surg 2018; 52:26-32. [PMID: 28329118 DOI: 10.1093/ejcts/ezx042] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2016] [Accepted: 01/03/2017] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES Surgeons at different institutions worldwide choose different types of operations for thymic tumours. It is not known whether these differences affect the outcomes of the patients. METHODS A total of 1430 patients with Masaoka-Koga pathological Stage I-II thymic tumours without myasthenia gravis or pre-treatment were identified from the International Thymic Malignancy Interest Group retrospective database. Outcomes of patients from 3 major continents (Europe, North America and Asia) were compared. RESULTS Patients from the 3 continents were comparable in gender and performance status. More European patients had more paraneoplastic syndromes; North American patients had the smallest tumour sizes and less adjuvant therapy; and Asian patients were younger and had more Stage I disease but higher grade tumours. Partial thymectomy was performed more often in Asian patients (31.7%) than in European (2.4%) and North American (5.4%; P < 0.001) patients. The median approach (sternotomy/clamshell) was the major approach in Europe (75.3%) and North America (76.6%). In contrast, the median approach was applied significantly less frequently in Asia (45.6%, P < 0.001); unilateral open (thoracotomy/hemi-clamshell, 23.3%) and minimally invasive approaches (video-assisted thoracoscopic surgery/robot, 31.1%) were used more often with similar rates of complete resection. The 10-year overall survival rate was 82% for Europe, 78% for North America and 90% for Asia ( P = 0.005), respectively. The 10-year cumulative recurrence rates were similar among the geographic groups (European 0.08, North American 0.07, and Asian 0.06, P = 0.61). Age was the only independent predictive factor for overall survival ( P < 0.001, HR = 1.089, 95% CI 1.056-1.123) in multivariable analysis. Types B3 and thymic carcinoma ( P = 0.003, HR = 3.932, 95% CI 1.615-9.576) were independent risk factors for increased recurrence. CONCLUSIONS This study shows that the selection of the surgical approach and the extent of resection for Stage I and II thymic tumours differ by geographic region. However, these differences seem to have little impact on outcomes.
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Affiliation(s)
- Wentao Fang
- Department of Thoracic Surgery, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Xiaopan Yao
- Division of Thoracic Surgery, Yale University, New Haven, CT, USA
| | | | - Zhitao Gu
- Department of Thoracic Surgery, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Frank Detterbeck
- Division of Thoracic Surgery, Yale University, New Haven, CT, USA
| | - Eric Vallières
- Division of Thoracic Surgery, Swedish Cancer Institute, Seattle, WA, USA
| | - Ralph W Aye
- Division of Thoracic Surgery, Swedish Cancer Institute, Seattle, WA, USA
| | | | - James Huang
- Department of Surgery-Thoracic Service, Memorial Sloan-Kettering Cancer Center, New York, NY, USA
| | - Yue Shang
- The Math Works, Inc., Natick, MA, USA
| | - Brian E Louie
- Division of Thoracic Surgery, Swedish Cancer Institute, Seattle, WA, USA
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Fang W, Gu Z, Chen K. [Minimally Invasive Surgery in Thymic Malignances]. ZHONGGUO FEI AI ZA ZHI = CHINESE JOURNAL OF LUNG CANCER 2018; 21:269-272. [PMID: 29587903 PMCID: PMC5973338 DOI: 10.3779/j.issn.1009-3419.2018.04.06] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
手术是胸腺肿瘤最重要的治疗方式。近年来,胸腺肿瘤的微创手术在国内外获得迅速推广。微创手术目前主要用于早期胸腺肿瘤的外科治疗,已有证据表明,微创手术可有效减少手术创伤、有效加快患者的术后恢复以及降低术后疼痛,并且目前已有一定临床证据初步证实其肿瘤学效果与开放手术相当。同时随着外科技术的不断进步,在保证外科学和肿瘤学原则的前提下,微创手术有可能使包括局部进展期、诱导治疗后以及复发转移的患者从中获益。
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Affiliation(s)
- Wentao Fang
- Department of Thoracic Surgery, Shanghai Chest Hospital, Shanghai Jiaotong University, Shanghai 200030, China
| | - Zhitao Gu
- Department of Thoracic Surgery, Shanghai Chest Hospital, Shanghai Jiaotong University, Shanghai 200030, China
| | - Keneng Chen
- Department of Thoracic Surgery, Beijing Cancer Hospital, Beijing 100142, China
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Ruffini E, Filosso PL, Guerrera F, Lausi P, Lyberis P, Oliaro A. Optimal surgical approach to thymic malignancies: New trends challenging old dogmas. Lung Cancer 2018; 118:161-170. [DOI: 10.1016/j.lungcan.2018.01.025] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2017] [Revised: 01/28/2018] [Accepted: 01/29/2018] [Indexed: 12/12/2022]
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Yano M, Fujii Y, Yoshida J, Utsumi T, Shiono H, Takao M, Tanahashi M, Saito Y. A Phase II Study of Partial and Subtotal Thymectomy for Thymoma (JART02). World J Surg 2018; 41:2033-2038. [PMID: 28324142 DOI: 10.1007/s00268-017-3990-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
BACKGROUND We believe the merit of preservation of a part of the thymus following surgery for thymoma. We evaluated the efficacy of partial or subtotal thymectomy for early-stage thymoma in the prospective study. METHODS The Japanese Association for Research on the Thymus conducted a multiple institutional study of thymectomy for thymoma localized in the thymus without total thymectomy. Patients without autoimmune disease who had an anterior mediastinal tumor that had been clinically diagnosed as an early-stage thymoma were enrolled in the study. Patients who were positive for anti-acetylcholine receptor antibodies were excluded. RESULTS Sixty-three patients were enrolled preoperatively; 27 patients were judged as being inappropriate based on the other thymic pathologies or tumor invasion. The remaining 36 cases were diagnosed as early-staged thymoma and analyzed. The mean age of the patients was 61 years. The mean maximal tumor diameter in the resected specimens was 3.6 cm. The most common pathological types of thymoma were AB (n = 10) and B1 (n = 10). The Masaoka stages were classified as stage I (n = 22) and II (n = 14). The mean observation period was 63 months. Two patients died due to respiratory dysfunction, which was not related to thymoma. One hundred percent of the patients remained recurrence-free. CONCLUSIONS This prospective study suggested the efficacy of partial or subtotal thymectomy for early-stage thymoma in patients without any apparent evidence of autoimmune disease. We can preserve a part of the thymus even following surgery for thymoma to prepare the possible second malignancies or diseases in future.
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Affiliation(s)
- Motoki Yano
- Division of Chest Surgery, Department of Surgery, Aichi Medical University, 1-1 Yazakokarimata, Nagakute, 480-1195, Japan.
| | - Yoshitaka Fujii
- Department of Oncology, Immunology and Surgery, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Junji Yoshida
- Divison of Thoracic Surgery, National Cancer Center Hospital East, Chiba, Japan
| | - Tomoki Utsumi
- Department of Surgery, National Hospital Organization Kinki-Chuo Chest Medical Center, Sakai, Japan
| | - Hiroyuki Shiono
- Department of Thoracic Surgery, Nara Hospital Kinki University Faculty of Medicine, Ikoma, Japan
| | - Motoshi Takao
- Department of Thoracic and Cardiovascular Surgery, Mie University Graduate School of Medicine, Tsu, Japan
| | - Masayuki Tanahashi
- Division of Thoracic Surgery, Respiratory Disease Center, Seirei Mikatahara General Hospital, Hamamatsu, Japan
| | - Yushi Saito
- Department of Thoracic Surgery, Toyota Memorial Hospital, Toyota, Japan
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Rusidanmu A, Huang S, Lv X. Is thymomectomy sufficient for non-myasthenic early stage thymoma patients? A retrospective, single center experience. Thorac Cancer 2017; 9:88-93. [PMID: 29087033 PMCID: PMC5754298 DOI: 10.1111/1759-7714.12542] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2017] [Revised: 09/16/2017] [Accepted: 09/17/2017] [Indexed: 11/28/2022] Open
Abstract
Background Thymic complete resection is considered the standard treatment for all thymic tumors; however, the ideal resection for non‐myasthenic early stage thymic tumors has not yet been determined. We conducted a retrospective study to examine this unique scenario. Methods We retrospectively analyzed the data of 118 early stage thymoma patients who underwent thymectomy (TM) or thymomectomy (TMM) with curative intent between January 2003 and December 2013 at our institution. Patients with myasthenia, thymic carcinomas, tumors with undetermined histology, and more advanced stage thymoma patients were excluded. We compared overall survival (OS) and disease‐free survival (DFS) according to the extent of thymic resection, tumor staging, and size. Results One hundred and eighteen patients were staged as early thymoma. TM was performed in 43 (35.6%) patients and TMM in 75 (64.4%). Forty‐nine (65.3%) patients with a tumor ≤ 3 cm underwent TMM, and 9 (20.9%) TM. Twenty‐six (34.7%) patients with a tumor > 3 cm underwent TMM, and 34 (79.1%) TM. Seventy‐four patients were categorized as stage I: 57 (76%) underwent TMM and 17 (39.5%) TM. Forty‐four patients were categorized as stage II: 18 (24%) underwent TMM and 26 (60.5%) TM. There was no statistically significant difference in recurrence between the groups (P = 0.250). Conclusion No difference in the rate of recurrence was observed in early stage non‐myasthenic patients following thymic resection and Masaoka–Koga staging. However, TM is considered a better option for early stage thymoma patients with tumors > 3 cm.
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Affiliation(s)
- Aizemaiti Rusidanmu
- Department of Thoracic Surgery, The First Affiliated Hospital, Zhejiang University, Hangzhou, China
| | - Sha Huang
- Department of Thoracic Surgery, The First Affiliated Hospital, Zhejiang University, Hangzhou, China
| | - Xiayi Lv
- Department of Thoracic Surgery, The First Affiliated Hospital, Zhejiang University, Hangzhou, China
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Tassi V, Ceccarelli S, Zannori C, Gili A, Daddi N, Bellezza G, Ascani S, Liberati AM, Puma F. Could thymomectomy be a reasonable option for non-myasthenic thymoma patients? J Thorac Dis 2017; 9:3817-3824. [PMID: 29268390 DOI: 10.21037/jtd.2017.09.109] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Background Complete resection is the mainstay of treatment for thymoma, but few studies have investigated the extent of resection on normal thymus. Extended thymectomy is considered the treatment of choice for myasthenic patients with thymoma, while the optimal therapy for non-myasthenic patients is still a matter of debate. The aim of this retrospective study was to compare extended thymectomy vs. thymomectomy in non-myasthenic thymoma patients for (I) oncological outcome, (II) multicentric thymoma occurrence and (III) postoperative myasthenia gravis (MG) development. Methods A retrospective comparative study was conducted on 92 non-myasthenic patients with completely resected thymoma, according to the extent of resection: extended thymectomy (70 patients) vs. R0-mediastinal thymomectomy (22 patients). Clinical and pathological characteristics, oncological outcome and postoperative MG occurrence were compared between the two study groups. Results We did not observe any significant differences in gender, age, symptomology, preoperative chemotherapy, histology, tumour size, adjuvant therapy or complications. There were no recorded postoperative mortalities. Stage distribution was different between the two groups: similar percentages of early stage thymoma for both groups were present, but there was a prevalence of stage III for extended thymectomy and stage IV for thymomectomy (P<0.01). At a median follow-up of 77.4 months (range 1-255 months), no statistically significant differences were recorded in local recurrence (P=0.396), thymoma related deaths (P=0.504), multicentric thymoma occurrence (P=0.742) and postoperative MG development (P=0.343). A high preoperative anti-acetylcholine receptor antibodies (ARAb) serum titer assay was statistically correlated with postoperative MG occurrence (r=0.49, P<0.05). Conclusions Thymomectomy appears to be a valid treatment option for non-myasthenic thymoma patients, as this procedure was associated to the same 5-year oncological results, compared to extended thymectomy, for both stage I-II small thymomas and patients with giant unilateral masses, as well as advanced diseases. Moreover, thymomectomy was not associated to an increased rate of postoperative MG.
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Affiliation(s)
- Valentina Tassi
- Department of Medical and Surgical Sciences (DIMEC), Alma Mater Studiorum, University of Bologna, Policlinico Sant'Orsola Malpighi, Bologna, Italy.,Division of Thoracic Surgery, Department of Surgical and Biomedical Sciences, S. Maria della Misericordia Hospital, University of Perugia Medical School, Perugia, Italy
| | - Silvia Ceccarelli
- Division of Thoracic Surgery, Department of Surgical and Biomedical Sciences, S. Maria della Misericordia Hospital, University of Perugia Medical School, Perugia, Italy
| | - Cristina Zannori
- Division of Onco-Hematology, S. Maria Terni Hospital, Department of Surgery and Medical Sciences, University of Perugia, Terni, Italy
| | - Alessio Gili
- Public Health Section, Department of Experimental Medicine, University of Perugia, Perugia, Italy
| | - Niccolò Daddi
- Department of Medical and Surgical Sciences (DIMEC), Alma Mater Studiorum, University of Bologna, Policlinico Sant'Orsola Malpighi, Bologna, Italy
| | - Guido Bellezza
- Section of Anatomic Pathology and Histology, Department of Experimental Medicine, University of Perugia Medical School, Perugia, Italy
| | - Stefano Ascani
- Section of Anatomic Pathology and Histology, S. Maria Terni Hospital and University of Perugia, Terni, Italy
| | - Anna Marina Liberati
- Division of Onco-Hematology, S. Maria Terni Hospital, Department of Surgery and Medical Sciences, University of Perugia, Terni, Italy
| | - Francesco Puma
- Division of Thoracic Surgery, Department of Surgical and Biomedical Sciences, S. Maria della Misericordia Hospital, University of Perugia Medical School, Perugia, Italy
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Robotic Resection of 3 cm and Larger Thymomas Is Associated With Low Perioperative Morbidity and Mortality. INNOVATIONS-TECHNOLOGY AND TECHNIQUES IN CARDIOTHORACIC AND VASCULAR SURGERY 2017; 11:321-326. [PMID: 27631952 DOI: 10.1097/imi.0000000000000295] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE The approach to thymoma resection has usually been determined by tumor size, although established guidelines do not exist. Minimally invasive approaches have been limited to tumors smaller than 5 cm, although 3 cm has been the suggested cutoff for performing an adequate oncologic procedure. No study has compared the perioperative outcomes of patients with 3 cm or larger tumors resected robotically versus sternotomy. METHODS We reviewed patients who underwent resection of 3 cm or larger thymomas from 2004 to 2014. Patients were divided based on approach: robotic and open thymectomy/thymomectomy. RESULTS Forty patients with tumors ranging from 3 to 13 cm were evaluated, 23 robotic and 17 open. Patient and tumor characteristics were similar. An R0 resection was primarily achieved: robotic, 91% (21/23); and open, 88% (15/17); P = 0.832. Adjuvant radiation rates were statistically equivalent: robotic, 17% (4/23) versus open, 41% (7/17); P = 0.191. Major postoperative complications were comparable: robotic, 4% (1/23) versus open, 29% (4/17); P = 0.184. Median chest tube duration was shorter for robotic (1 day) versus open (3 days); P = 0.001. The robotic approach had a shorter median intensive care unit stay compared to open (0 days vs 1 day); P = 0.024. The median hospital stay was shorter for robotic (2 days) versus open (5 days); P < 0.001. CONCLUSIONS In 3 cm or larger thymomas, robotic thymectomy is feasible based on the ability to achieve a complete resection with similar adjuvant radiation therapy rates. Perioperatively, robotic thymectomy is associated with lower morbidity; and shorter chest tube duration, intensive care unit stay, and hospital stay compared to open. However, oncologic outcomes are immature and require prolonged surveillance.
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28
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Narm KS, Lee CY, Do YW, Jung HS, Byun GE, Lee JG, Kim DJ, Hwang Y, Park IK, Kang CH, Kim YT, Cho JH, Choi YS, Kim J, Shim YM, Hwang SK, Kim YH, Kim DK, Park SI, Chung KY. Limited thymectomy as a potential alternative treatment option for early-stage thymoma: A multi-institutional propensity-matched study. Lung Cancer 2016; 101:22-27. [DOI: 10.1016/j.lungcan.2016.06.021] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2016] [Revised: 06/21/2016] [Accepted: 06/26/2016] [Indexed: 11/17/2022]
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Wilshire CL, Vallières E, Shultz D, Aye RW, Farivar AS, Louie BE. Robotic Resection of 3 Cm and Larger Thymomas is Associated with Low Perioperative Morbidity and Mortality. INNOVATIONS-TECHNOLOGY AND TECHNIQUES IN CARDIOTHORACIC AND VASCULAR SURGERY 2016. [DOI: 10.1177/155698451601100503] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
| | - Eric Vallières
- Division of Thoracic Surgery, Swedish Cancer Institute, Seattle, WA USA
| | - Dale Shultz
- Division of Thoracic Surgery, Swedish Cancer Institute, Seattle, WA USA
| | - Ralph W. Aye
- Division of Thoracic Surgery, Swedish Cancer Institute, Seattle, WA USA
| | | | - Brian E. Louie
- Division of Thoracic Surgery, Swedish Cancer Institute, Seattle, WA USA
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30
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Keijzers M, Maessen JG. Thymomectomy in early stage thymomas-case closed? J Thorac Dis 2016; 8:1440-2. [PMID: 27501512 DOI: 10.21037/jtd.2016.05.39] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Marlies Keijzers
- Department of Cardiothoracic Surgery, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Jos G Maessen
- Department of Cardiothoracic Surgery, Maastricht University Medical Center, Maastricht, The Netherlands
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Gu Z, Fu J, Shen Y, Wei Y, Tan L, Zhang P, Han Y, Chen C, Zhang R, Li Y, Chen KN, Chen H, Liu Y, Cui Y, Wang Y, Pang L, Yu Z, Zhou X, Liu Y, Liu Y, Fang W. [Thymectomy versus Tumor Resection for Early-stage Thymic Malignancies: A Chinese Alliance for Research in Thymomas (ChART) Retrospective Database Analysis]. ZHONGGUO FEI AI ZA ZHI = CHINESE JOURNAL OF LUNG CANCER 2016; 19:459-64. [PMID: 27339723 PMCID: PMC6133978 DOI: 10.3779/j.issn.1009-3419.2016.07.08] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
背景与目的 探采用中国胸腺肿瘤协作组胸腺肿瘤多中心回顾性数据库,探讨胸腺切除范围对早期胸腺上皮肿瘤预后的影响。 方法 选择Masaoka-Koga分期Ⅰ期、Ⅱ期且术前没有接受新辅助治疗的患者,根据术中胸腺切除程度,分为胸腺切除组及胸腺瘤切除组。对比分析两组患者的临床特点及预后差异。 结果 共有1, 047例患者纳入研究,其中胸腺切除组入组796例患者、胸腺瘤切除组入组251例患者。对于术前合并重症肌无力(myasthenia gravis, MG)的患者,胸腺切除组术后的MG的缓解率明显优于胸腺瘤切除组(91.6% vs 50.0%, P < 0.001)。胸腺切除组的10年总体生存率(overall survival, OS)为90.9%,胸腺瘤切除组的10年OS为89.4%,两者之间没有统计学差异(P=0.732)。胸腺切除组术后复发率为3.7%,胸腺瘤切除组术后复发率为6.2%,两组之间无统计学差异(P=0.149)。进一步分层分析显示,对于Masaoka-Koga Ⅰ期患者,胸腺切除组和胸腺瘤切除组在复发率上没有差异(3.2% vs 1.4%, P=0.259);然而在Masaoka-Koga Ⅱ期患者中,胸腺切除组的复发率明显低于胸腺瘤切除组的复发率(2.9% vs 14.5%, P=0.001)。 结论 胸腺切除是治疗胸腺上皮肿瘤的标准手术方式,特别是对于Masaoka-Koga Ⅱ期及合并MG的患者。
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Affiliation(s)
- Zhitao Gu
- Department of Thoracic Surgery, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai 200030, China
| | - Jianhua Fu
- Department of Thoracic Surgery, Guangdong Esophageal Cancer Institute, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center of Cancer Medicine, Guangzhou 510060, China
| | - Yi Shen
- Department of Thoracic Surgery, Affiliated Hospital of Qingdao University, Qingdao 266001, China
| | - Yucheng Wei
- Department of Thoracic Surgery, Affiliated Hospital of Qingdao University, Qingdao 266001, China
| | - Lijie Tan
- Department of Thoracic Surgery, Zhongshan Hospital, Fudan University, Shanghai 200032, China
| | - Peng Zhang
- Department of Endocrinology, Tianjin Medical University General Hospital, Tianjin 300052, China
| | - Yongtao Han
- Department of Thoracic Surgery, Sichuan Cancer Hospital, Chengdu 610041, China
| | - Chun Chen
- Department of Thoracic Surgery, Fujian Medical University Union Hospital, Fuzhou 350001, China
| | - Renquan Zhang
- Department of Thoracic Surgery, First Affiliated Hospital of Anhui Medical University, Hefei 230022, China
| | - Yin Li
- Department of Thoracic Surgery, Affiliated Cancer Hospital of Zhengzhou University, Zhengzhou 450008, China
| | - Ke-Neng Chen
- Department of Thoracic Surgery, Beijing Cancer Hospital, Beijing 100142, China
| | - Hezhong Chen
- Department of Cardiothoracic Surgery, Changhai Hospital, Shanghai 200433, China
| | - Yongyu Liu
- Department of Thoracic Surgery, Liaoning Cancer Hospital, Shenyang 110042, China
| | - Youbing Cui
- Department of Thoracic Surgery, First Affiliated Hospital of Jilin University, Changchun 130021, China
| | - Yun Wang
- Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu 610041, China
| | - Liewen Pang
- Department of Thoracic Surgery, Huashan Hospital, Fudan University, Shanghai 200032, China
| | - Zhentao Yu
- Department of Esophageal Cancer, Tianjin Cancer Hospital, Tianjin 300060, China
| | - Xinming Zhou
- Department of Thoracic Surgery, Zhejiang Cancer Hospital, Hangzhou 310022, China
| | - Yangchun Liu
- Department of Thoracic Surgery, Jiangxi People's Hospital, Nanchang 330006, China
| | - Yuan Liu
- Department of Thoracic Surgery, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai 200030, China
| | - Wentao Fang
- Department of Thoracic Surgery, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai 200030, China
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Gu Z, Fu J, Shen Y, Wei Y, Tan L, Zhang P, Han Y, Chen C, Zhang R, Li Y, Chen K, Chen H, Liu Y, Cui Y, Wang Y, Pang L, Yu Z, Zhou X, Liu Y, Liu Y, Fang W. Thymectomy versus tumor resection for early-stage thymic malignancies: a Chinese Alliance for Research in Thymomas retrospective database analysis. J Thorac Dis 2016; 8:680-6. [PMID: 27114835 DOI: 10.21037/jtd.2016.03.16] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
BACKGROUND To evaluate the surgical outcomes of tumor resection with or without total thymectomy for thymic epithelial tumors (TETs) using the Chinese Alliance for Research in Thymomas (ChART) retrospective database. METHODS Patients without preoperative therapy, who underwent surgery for early-stage (Masaoka-Koga stage I and II) tumors, were enrolled for the study. They were divided into thymectomy and thymomectomy groups according to the resection extent of the thymus. Demographic and surgical outcomes were compared between the two patients groups. RESULTS A total of 1,047 patients were enrolled, with 796 cases in the thymectomy group and 251 cases in the thymomectomy group. Improvement rate of myasthenia gravis (MG) was higher after thymectomy than after thymomectomy (91.6% vs. 50.0%, P<0.001). Ten-year overall survival was similar between the two groups (90.9% after thymectomy and 89.4% after thymomectomy, P=0.732). Overall, recurrence rate was 3.1% after thymectomy and 5.4% after thymomectomy, with no significant difference between the two groups (P=0.149). Stratified analysis revealed no significant difference in recurrence rates in Masaoka-Koga stage I tumors (3.2% vs. 1.4%, P=0.259). However in patients with Masaoka-Koga stage II tumors, recurrence was significantly less after thymectomy group than after thymomectomy (2.9% vs. 14.5%, P=0.001). CONCLUSIONS Thymectomy, instead of tumor resection alone, should still be recommended as the surgical standard for thymic malignancies, especially for stage II tumors and those with concomitant MG.
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Affiliation(s)
- Zhitao Gu
- 1 Department of Thoracic Surgery, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai 200030, China ; 2 Department of Thoracic Surgery, Guangdong Esophageal Cancer Institute, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center of Cancer Medicine, Guangzhou 510060, China ; 3 Department of Thoracic Surgery, Affiliated Hospital of Qingdao University, Qingdao 266001, China ; 4 Department of Thoracic Surgery, Zhongshan Hospital, Fudan University, Shanghai 200032, China ; 5 Department of Endocrinology, Tianjin Medical University General Hospital, Tianjin 300052, China ; 6 Department of Thoracic Surgery, Sichuan Cancer Hospital, Chengdu 610041, China ; 7 Department of Thoracic Surgery, Fujian Medical University Union Hospital, Fuzhou 350001, China ; 8 Department of Thoracic Surgery, First Affiliated Hospital of Anhui Medical University, Hefei 230022, China ; 9 Department of Thoracic Surgery, Affiliated Cancer Hospital of Zhengzhou University, Zhengzhou 450008, China ; 10 Department of Thoracic Surgery, Beijing Cancer Hospital, Beijing 100142, China ; 11 Department of Cardiothoracic Surgery, Changhai Hospital, Shanghai 200433, China ; 12 Department of Thoracic Surgery, Liaoning Cancer Hospital, Shenyang 110042, China ; 13 Department of Thoracic Surgery, First Affiliated Hospital of Jilin University, Changchun 130021, China ; 14 Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu 610041, China ; 15 Department of Thoracic Surgery, Huashan Hospital, Fudan University, Shanghai 200032, China ; 16 Department of Esophageal Cancer, Tianjin Cancer Hospital, Tianjin 300060, China ; 17 Department of Thoracic Surgery, Zhejiang Cancer Hospital, Hangzhou 310022, China ; 18 Department of Thoracic Surgery, Jiangxi People's Hospital, Nanchang 330006, China
| | - Jianhua Fu
- 1 Department of Thoracic Surgery, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai 200030, China ; 2 Department of Thoracic Surgery, Guangdong Esophageal Cancer Institute, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center of Cancer Medicine, Guangzhou 510060, China ; 3 Department of Thoracic Surgery, Affiliated Hospital of Qingdao University, Qingdao 266001, China ; 4 Department of Thoracic Surgery, Zhongshan Hospital, Fudan University, Shanghai 200032, China ; 5 Department of Endocrinology, Tianjin Medical University General Hospital, Tianjin 300052, China ; 6 Department of Thoracic Surgery, Sichuan Cancer Hospital, Chengdu 610041, China ; 7 Department of Thoracic Surgery, Fujian Medical University Union Hospital, Fuzhou 350001, China ; 8 Department of Thoracic Surgery, First Affiliated Hospital of Anhui Medical University, Hefei 230022, China ; 9 Department of Thoracic Surgery, Affiliated Cancer Hospital of Zhengzhou University, Zhengzhou 450008, China ; 10 Department of Thoracic Surgery, Beijing Cancer Hospital, Beijing 100142, China ; 11 Department of Cardiothoracic Surgery, Changhai Hospital, Shanghai 200433, China ; 12 Department of Thoracic Surgery, Liaoning Cancer Hospital, Shenyang 110042, China ; 13 Department of Thoracic Surgery, First Affiliated Hospital of Jilin University, Changchun 130021, China ; 14 Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu 610041, China ; 15 Department of Thoracic Surgery, Huashan Hospital, Fudan University, Shanghai 200032, China ; 16 Department of Esophageal Cancer, Tianjin Cancer Hospital, Tianjin 300060, China ; 17 Department of Thoracic Surgery, Zhejiang Cancer Hospital, Hangzhou 310022, China ; 18 Department of Thoracic Surgery, Jiangxi People's Hospital, Nanchang 330006, China
| | - Yi Shen
- 1 Department of Thoracic Surgery, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai 200030, China ; 2 Department of Thoracic Surgery, Guangdong Esophageal Cancer Institute, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center of Cancer Medicine, Guangzhou 510060, China ; 3 Department of Thoracic Surgery, Affiliated Hospital of Qingdao University, Qingdao 266001, China ; 4 Department of Thoracic Surgery, Zhongshan Hospital, Fudan University, Shanghai 200032, China ; 5 Department of Endocrinology, Tianjin Medical University General Hospital, Tianjin 300052, China ; 6 Department of Thoracic Surgery, Sichuan Cancer Hospital, Chengdu 610041, China ; 7 Department of Thoracic Surgery, Fujian Medical University Union Hospital, Fuzhou 350001, China ; 8 Department of Thoracic Surgery, First Affiliated Hospital of Anhui Medical University, Hefei 230022, China ; 9 Department of Thoracic Surgery, Affiliated Cancer Hospital of Zhengzhou University, Zhengzhou 450008, China ; 10 Department of Thoracic Surgery, Beijing Cancer Hospital, Beijing 100142, China ; 11 Department of Cardiothoracic Surgery, Changhai Hospital, Shanghai 200433, China ; 12 Department of Thoracic Surgery, Liaoning Cancer Hospital, Shenyang 110042, China ; 13 Department of Thoracic Surgery, First Affiliated Hospital of Jilin University, Changchun 130021, China ; 14 Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu 610041, China ; 15 Department of Thoracic Surgery, Huashan Hospital, Fudan University, Shanghai 200032, China ; 16 Department of Esophageal Cancer, Tianjin Cancer Hospital, Tianjin 300060, China ; 17 Department of Thoracic Surgery, Zhejiang Cancer Hospital, Hangzhou 310022, China ; 18 Department of Thoracic Surgery, Jiangxi People's Hospital, Nanchang 330006, China
| | - Yucheng Wei
- 1 Department of Thoracic Surgery, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai 200030, China ; 2 Department of Thoracic Surgery, Guangdong Esophageal Cancer Institute, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center of Cancer Medicine, Guangzhou 510060, China ; 3 Department of Thoracic Surgery, Affiliated Hospital of Qingdao University, Qingdao 266001, China ; 4 Department of Thoracic Surgery, Zhongshan Hospital, Fudan University, Shanghai 200032, China ; 5 Department of Endocrinology, Tianjin Medical University General Hospital, Tianjin 300052, China ; 6 Department of Thoracic Surgery, Sichuan Cancer Hospital, Chengdu 610041, China ; 7 Department of Thoracic Surgery, Fujian Medical University Union Hospital, Fuzhou 350001, China ; 8 Department of Thoracic Surgery, First Affiliated Hospital of Anhui Medical University, Hefei 230022, China ; 9 Department of Thoracic Surgery, Affiliated Cancer Hospital of Zhengzhou University, Zhengzhou 450008, China ; 10 Department of Thoracic Surgery, Beijing Cancer Hospital, Beijing 100142, China ; 11 Department of Cardiothoracic Surgery, Changhai Hospital, Shanghai 200433, China ; 12 Department of Thoracic Surgery, Liaoning Cancer Hospital, Shenyang 110042, China ; 13 Department of Thoracic Surgery, First Affiliated Hospital of Jilin University, Changchun 130021, China ; 14 Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu 610041, China ; 15 Department of Thoracic Surgery, Huashan Hospital, Fudan University, Shanghai 200032, China ; 16 Department of Esophageal Cancer, Tianjin Cancer Hospital, Tianjin 300060, China ; 17 Department of Thoracic Surgery, Zhejiang Cancer Hospital, Hangzhou 310022, China ; 18 Department of Thoracic Surgery, Jiangxi People's Hospital, Nanchang 330006, China
| | - Lijie Tan
- 1 Department of Thoracic Surgery, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai 200030, China ; 2 Department of Thoracic Surgery, Guangdong Esophageal Cancer Institute, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center of Cancer Medicine, Guangzhou 510060, China ; 3 Department of Thoracic Surgery, Affiliated Hospital of Qingdao University, Qingdao 266001, China ; 4 Department of Thoracic Surgery, Zhongshan Hospital, Fudan University, Shanghai 200032, China ; 5 Department of Endocrinology, Tianjin Medical University General Hospital, Tianjin 300052, China ; 6 Department of Thoracic Surgery, Sichuan Cancer Hospital, Chengdu 610041, China ; 7 Department of Thoracic Surgery, Fujian Medical University Union Hospital, Fuzhou 350001, China ; 8 Department of Thoracic Surgery, First Affiliated Hospital of Anhui Medical University, Hefei 230022, China ; 9 Department of Thoracic Surgery, Affiliated Cancer Hospital of Zhengzhou University, Zhengzhou 450008, China ; 10 Department of Thoracic Surgery, Beijing Cancer Hospital, Beijing 100142, China ; 11 Department of Cardiothoracic Surgery, Changhai Hospital, Shanghai 200433, China ; 12 Department of Thoracic Surgery, Liaoning Cancer Hospital, Shenyang 110042, China ; 13 Department of Thoracic Surgery, First Affiliated Hospital of Jilin University, Changchun 130021, China ; 14 Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu 610041, China ; 15 Department of Thoracic Surgery, Huashan Hospital, Fudan University, Shanghai 200032, China ; 16 Department of Esophageal Cancer, Tianjin Cancer Hospital, Tianjin 300060, China ; 17 Department of Thoracic Surgery, Zhejiang Cancer Hospital, Hangzhou 310022, China ; 18 Department of Thoracic Surgery, Jiangxi People's Hospital, Nanchang 330006, China
| | - Peng Zhang
- 1 Department of Thoracic Surgery, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai 200030, China ; 2 Department of Thoracic Surgery, Guangdong Esophageal Cancer Institute, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center of Cancer Medicine, Guangzhou 510060, China ; 3 Department of Thoracic Surgery, Affiliated Hospital of Qingdao University, Qingdao 266001, China ; 4 Department of Thoracic Surgery, Zhongshan Hospital, Fudan University, Shanghai 200032, China ; 5 Department of Endocrinology, Tianjin Medical University General Hospital, Tianjin 300052, China ; 6 Department of Thoracic Surgery, Sichuan Cancer Hospital, Chengdu 610041, China ; 7 Department of Thoracic Surgery, Fujian Medical University Union Hospital, Fuzhou 350001, China ; 8 Department of Thoracic Surgery, First Affiliated Hospital of Anhui Medical University, Hefei 230022, China ; 9 Department of Thoracic Surgery, Affiliated Cancer Hospital of Zhengzhou University, Zhengzhou 450008, China ; 10 Department of Thoracic Surgery, Beijing Cancer Hospital, Beijing 100142, China ; 11 Department of Cardiothoracic Surgery, Changhai Hospital, Shanghai 200433, China ; 12 Department of Thoracic Surgery, Liaoning Cancer Hospital, Shenyang 110042, China ; 13 Department of Thoracic Surgery, First Affiliated Hospital of Jilin University, Changchun 130021, China ; 14 Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu 610041, China ; 15 Department of Thoracic Surgery, Huashan Hospital, Fudan University, Shanghai 200032, China ; 16 Department of Esophageal Cancer, Tianjin Cancer Hospital, Tianjin 300060, China ; 17 Department of Thoracic Surgery, Zhejiang Cancer Hospital, Hangzhou 310022, China ; 18 Department of Thoracic Surgery, Jiangxi People's Hospital, Nanchang 330006, China
| | - Yongtao Han
- 1 Department of Thoracic Surgery, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai 200030, China ; 2 Department of Thoracic Surgery, Guangdong Esophageal Cancer Institute, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center of Cancer Medicine, Guangzhou 510060, China ; 3 Department of Thoracic Surgery, Affiliated Hospital of Qingdao University, Qingdao 266001, China ; 4 Department of Thoracic Surgery, Zhongshan Hospital, Fudan University, Shanghai 200032, China ; 5 Department of Endocrinology, Tianjin Medical University General Hospital, Tianjin 300052, China ; 6 Department of Thoracic Surgery, Sichuan Cancer Hospital, Chengdu 610041, China ; 7 Department of Thoracic Surgery, Fujian Medical University Union Hospital, Fuzhou 350001, China ; 8 Department of Thoracic Surgery, First Affiliated Hospital of Anhui Medical University, Hefei 230022, China ; 9 Department of Thoracic Surgery, Affiliated Cancer Hospital of Zhengzhou University, Zhengzhou 450008, China ; 10 Department of Thoracic Surgery, Beijing Cancer Hospital, Beijing 100142, China ; 11 Department of Cardiothoracic Surgery, Changhai Hospital, Shanghai 200433, China ; 12 Department of Thoracic Surgery, Liaoning Cancer Hospital, Shenyang 110042, China ; 13 Department of Thoracic Surgery, First Affiliated Hospital of Jilin University, Changchun 130021, China ; 14 Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu 610041, China ; 15 Department of Thoracic Surgery, Huashan Hospital, Fudan University, Shanghai 200032, China ; 16 Department of Esophageal Cancer, Tianjin Cancer Hospital, Tianjin 300060, China ; 17 Department of Thoracic Surgery, Zhejiang Cancer Hospital, Hangzhou 310022, China ; 18 Department of Thoracic Surgery, Jiangxi People's Hospital, Nanchang 330006, China
| | - Chun Chen
- 1 Department of Thoracic Surgery, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai 200030, China ; 2 Department of Thoracic Surgery, Guangdong Esophageal Cancer Institute, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center of Cancer Medicine, Guangzhou 510060, China ; 3 Department of Thoracic Surgery, Affiliated Hospital of Qingdao University, Qingdao 266001, China ; 4 Department of Thoracic Surgery, Zhongshan Hospital, Fudan University, Shanghai 200032, China ; 5 Department of Endocrinology, Tianjin Medical University General Hospital, Tianjin 300052, China ; 6 Department of Thoracic Surgery, Sichuan Cancer Hospital, Chengdu 610041, China ; 7 Department of Thoracic Surgery, Fujian Medical University Union Hospital, Fuzhou 350001, China ; 8 Department of Thoracic Surgery, First Affiliated Hospital of Anhui Medical University, Hefei 230022, China ; 9 Department of Thoracic Surgery, Affiliated Cancer Hospital of Zhengzhou University, Zhengzhou 450008, China ; 10 Department of Thoracic Surgery, Beijing Cancer Hospital, Beijing 100142, China ; 11 Department of Cardiothoracic Surgery, Changhai Hospital, Shanghai 200433, China ; 12 Department of Thoracic Surgery, Liaoning Cancer Hospital, Shenyang 110042, China ; 13 Department of Thoracic Surgery, First Affiliated Hospital of Jilin University, Changchun 130021, China ; 14 Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu 610041, China ; 15 Department of Thoracic Surgery, Huashan Hospital, Fudan University, Shanghai 200032, China ; 16 Department of Esophageal Cancer, Tianjin Cancer Hospital, Tianjin 300060, China ; 17 Department of Thoracic Surgery, Zhejiang Cancer Hospital, Hangzhou 310022, China ; 18 Department of Thoracic Surgery, Jiangxi People's Hospital, Nanchang 330006, China
| | - Renquan Zhang
- 1 Department of Thoracic Surgery, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai 200030, China ; 2 Department of Thoracic Surgery, Guangdong Esophageal Cancer Institute, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center of Cancer Medicine, Guangzhou 510060, China ; 3 Department of Thoracic Surgery, Affiliated Hospital of Qingdao University, Qingdao 266001, China ; 4 Department of Thoracic Surgery, Zhongshan Hospital, Fudan University, Shanghai 200032, China ; 5 Department of Endocrinology, Tianjin Medical University General Hospital, Tianjin 300052, China ; 6 Department of Thoracic Surgery, Sichuan Cancer Hospital, Chengdu 610041, China ; 7 Department of Thoracic Surgery, Fujian Medical University Union Hospital, Fuzhou 350001, China ; 8 Department of Thoracic Surgery, First Affiliated Hospital of Anhui Medical University, Hefei 230022, China ; 9 Department of Thoracic Surgery, Affiliated Cancer Hospital of Zhengzhou University, Zhengzhou 450008, China ; 10 Department of Thoracic Surgery, Beijing Cancer Hospital, Beijing 100142, China ; 11 Department of Cardiothoracic Surgery, Changhai Hospital, Shanghai 200433, China ; 12 Department of Thoracic Surgery, Liaoning Cancer Hospital, Shenyang 110042, China ; 13 Department of Thoracic Surgery, First Affiliated Hospital of Jilin University, Changchun 130021, China ; 14 Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu 610041, China ; 15 Department of Thoracic Surgery, Huashan Hospital, Fudan University, Shanghai 200032, China ; 16 Department of Esophageal Cancer, Tianjin Cancer Hospital, Tianjin 300060, China ; 17 Department of Thoracic Surgery, Zhejiang Cancer Hospital, Hangzhou 310022, China ; 18 Department of Thoracic Surgery, Jiangxi People's Hospital, Nanchang 330006, China
| | - Yin Li
- 1 Department of Thoracic Surgery, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai 200030, China ; 2 Department of Thoracic Surgery, Guangdong Esophageal Cancer Institute, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center of Cancer Medicine, Guangzhou 510060, China ; 3 Department of Thoracic Surgery, Affiliated Hospital of Qingdao University, Qingdao 266001, China ; 4 Department of Thoracic Surgery, Zhongshan Hospital, Fudan University, Shanghai 200032, China ; 5 Department of Endocrinology, Tianjin Medical University General Hospital, Tianjin 300052, China ; 6 Department of Thoracic Surgery, Sichuan Cancer Hospital, Chengdu 610041, China ; 7 Department of Thoracic Surgery, Fujian Medical University Union Hospital, Fuzhou 350001, China ; 8 Department of Thoracic Surgery, First Affiliated Hospital of Anhui Medical University, Hefei 230022, China ; 9 Department of Thoracic Surgery, Affiliated Cancer Hospital of Zhengzhou University, Zhengzhou 450008, China ; 10 Department of Thoracic Surgery, Beijing Cancer Hospital, Beijing 100142, China ; 11 Department of Cardiothoracic Surgery, Changhai Hospital, Shanghai 200433, China ; 12 Department of Thoracic Surgery, Liaoning Cancer Hospital, Shenyang 110042, China ; 13 Department of Thoracic Surgery, First Affiliated Hospital of Jilin University, Changchun 130021, China ; 14 Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu 610041, China ; 15 Department of Thoracic Surgery, Huashan Hospital, Fudan University, Shanghai 200032, China ; 16 Department of Esophageal Cancer, Tianjin Cancer Hospital, Tianjin 300060, China ; 17 Department of Thoracic Surgery, Zhejiang Cancer Hospital, Hangzhou 310022, China ; 18 Department of Thoracic Surgery, Jiangxi People's Hospital, Nanchang 330006, China
| | - Keneng Chen
- 1 Department of Thoracic Surgery, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai 200030, China ; 2 Department of Thoracic Surgery, Guangdong Esophageal Cancer Institute, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center of Cancer Medicine, Guangzhou 510060, China ; 3 Department of Thoracic Surgery, Affiliated Hospital of Qingdao University, Qingdao 266001, China ; 4 Department of Thoracic Surgery, Zhongshan Hospital, Fudan University, Shanghai 200032, China ; 5 Department of Endocrinology, Tianjin Medical University General Hospital, Tianjin 300052, China ; 6 Department of Thoracic Surgery, Sichuan Cancer Hospital, Chengdu 610041, China ; 7 Department of Thoracic Surgery, Fujian Medical University Union Hospital, Fuzhou 350001, China ; 8 Department of Thoracic Surgery, First Affiliated Hospital of Anhui Medical University, Hefei 230022, China ; 9 Department of Thoracic Surgery, Affiliated Cancer Hospital of Zhengzhou University, Zhengzhou 450008, China ; 10 Department of Thoracic Surgery, Beijing Cancer Hospital, Beijing 100142, China ; 11 Department of Cardiothoracic Surgery, Changhai Hospital, Shanghai 200433, China ; 12 Department of Thoracic Surgery, Liaoning Cancer Hospital, Shenyang 110042, China ; 13 Department of Thoracic Surgery, First Affiliated Hospital of Jilin University, Changchun 130021, China ; 14 Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu 610041, China ; 15 Department of Thoracic Surgery, Huashan Hospital, Fudan University, Shanghai 200032, China ; 16 Department of Esophageal Cancer, Tianjin Cancer Hospital, Tianjin 300060, China ; 17 Department of Thoracic Surgery, Zhejiang Cancer Hospital, Hangzhou 310022, China ; 18 Department of Thoracic Surgery, Jiangxi People's Hospital, Nanchang 330006, China
| | - Hezhong Chen
- 1 Department of Thoracic Surgery, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai 200030, China ; 2 Department of Thoracic Surgery, Guangdong Esophageal Cancer Institute, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center of Cancer Medicine, Guangzhou 510060, China ; 3 Department of Thoracic Surgery, Affiliated Hospital of Qingdao University, Qingdao 266001, China ; 4 Department of Thoracic Surgery, Zhongshan Hospital, Fudan University, Shanghai 200032, China ; 5 Department of Endocrinology, Tianjin Medical University General Hospital, Tianjin 300052, China ; 6 Department of Thoracic Surgery, Sichuan Cancer Hospital, Chengdu 610041, China ; 7 Department of Thoracic Surgery, Fujian Medical University Union Hospital, Fuzhou 350001, China ; 8 Department of Thoracic Surgery, First Affiliated Hospital of Anhui Medical University, Hefei 230022, China ; 9 Department of Thoracic Surgery, Affiliated Cancer Hospital of Zhengzhou University, Zhengzhou 450008, China ; 10 Department of Thoracic Surgery, Beijing Cancer Hospital, Beijing 100142, China ; 11 Department of Cardiothoracic Surgery, Changhai Hospital, Shanghai 200433, China ; 12 Department of Thoracic Surgery, Liaoning Cancer Hospital, Shenyang 110042, China ; 13 Department of Thoracic Surgery, First Affiliated Hospital of Jilin University, Changchun 130021, China ; 14 Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu 610041, China ; 15 Department of Thoracic Surgery, Huashan Hospital, Fudan University, Shanghai 200032, China ; 16 Department of Esophageal Cancer, Tianjin Cancer Hospital, Tianjin 300060, China ; 17 Department of Thoracic Surgery, Zhejiang Cancer Hospital, Hangzhou 310022, China ; 18 Department of Thoracic Surgery, Jiangxi People's Hospital, Nanchang 330006, China
| | - Yongyu Liu
- 1 Department of Thoracic Surgery, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai 200030, China ; 2 Department of Thoracic Surgery, Guangdong Esophageal Cancer Institute, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center of Cancer Medicine, Guangzhou 510060, China ; 3 Department of Thoracic Surgery, Affiliated Hospital of Qingdao University, Qingdao 266001, China ; 4 Department of Thoracic Surgery, Zhongshan Hospital, Fudan University, Shanghai 200032, China ; 5 Department of Endocrinology, Tianjin Medical University General Hospital, Tianjin 300052, China ; 6 Department of Thoracic Surgery, Sichuan Cancer Hospital, Chengdu 610041, China ; 7 Department of Thoracic Surgery, Fujian Medical University Union Hospital, Fuzhou 350001, China ; 8 Department of Thoracic Surgery, First Affiliated Hospital of Anhui Medical University, Hefei 230022, China ; 9 Department of Thoracic Surgery, Affiliated Cancer Hospital of Zhengzhou University, Zhengzhou 450008, China ; 10 Department of Thoracic Surgery, Beijing Cancer Hospital, Beijing 100142, China ; 11 Department of Cardiothoracic Surgery, Changhai Hospital, Shanghai 200433, China ; 12 Department of Thoracic Surgery, Liaoning Cancer Hospital, Shenyang 110042, China ; 13 Department of Thoracic Surgery, First Affiliated Hospital of Jilin University, Changchun 130021, China ; 14 Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu 610041, China ; 15 Department of Thoracic Surgery, Huashan Hospital, Fudan University, Shanghai 200032, China ; 16 Department of Esophageal Cancer, Tianjin Cancer Hospital, Tianjin 300060, China ; 17 Department of Thoracic Surgery, Zhejiang Cancer Hospital, Hangzhou 310022, China ; 18 Department of Thoracic Surgery, Jiangxi People's Hospital, Nanchang 330006, China
| | - Youbing Cui
- 1 Department of Thoracic Surgery, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai 200030, China ; 2 Department of Thoracic Surgery, Guangdong Esophageal Cancer Institute, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center of Cancer Medicine, Guangzhou 510060, China ; 3 Department of Thoracic Surgery, Affiliated Hospital of Qingdao University, Qingdao 266001, China ; 4 Department of Thoracic Surgery, Zhongshan Hospital, Fudan University, Shanghai 200032, China ; 5 Department of Endocrinology, Tianjin Medical University General Hospital, Tianjin 300052, China ; 6 Department of Thoracic Surgery, Sichuan Cancer Hospital, Chengdu 610041, China ; 7 Department of Thoracic Surgery, Fujian Medical University Union Hospital, Fuzhou 350001, China ; 8 Department of Thoracic Surgery, First Affiliated Hospital of Anhui Medical University, Hefei 230022, China ; 9 Department of Thoracic Surgery, Affiliated Cancer Hospital of Zhengzhou University, Zhengzhou 450008, China ; 10 Department of Thoracic Surgery, Beijing Cancer Hospital, Beijing 100142, China ; 11 Department of Cardiothoracic Surgery, Changhai Hospital, Shanghai 200433, China ; 12 Department of Thoracic Surgery, Liaoning Cancer Hospital, Shenyang 110042, China ; 13 Department of Thoracic Surgery, First Affiliated Hospital of Jilin University, Changchun 130021, China ; 14 Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu 610041, China ; 15 Department of Thoracic Surgery, Huashan Hospital, Fudan University, Shanghai 200032, China ; 16 Department of Esophageal Cancer, Tianjin Cancer Hospital, Tianjin 300060, China ; 17 Department of Thoracic Surgery, Zhejiang Cancer Hospital, Hangzhou 310022, China ; 18 Department of Thoracic Surgery, Jiangxi People's Hospital, Nanchang 330006, China
| | - Yun Wang
- 1 Department of Thoracic Surgery, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai 200030, China ; 2 Department of Thoracic Surgery, Guangdong Esophageal Cancer Institute, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center of Cancer Medicine, Guangzhou 510060, China ; 3 Department of Thoracic Surgery, Affiliated Hospital of Qingdao University, Qingdao 266001, China ; 4 Department of Thoracic Surgery, Zhongshan Hospital, Fudan University, Shanghai 200032, China ; 5 Department of Endocrinology, Tianjin Medical University General Hospital, Tianjin 300052, China ; 6 Department of Thoracic Surgery, Sichuan Cancer Hospital, Chengdu 610041, China ; 7 Department of Thoracic Surgery, Fujian Medical University Union Hospital, Fuzhou 350001, China ; 8 Department of Thoracic Surgery, First Affiliated Hospital of Anhui Medical University, Hefei 230022, China ; 9 Department of Thoracic Surgery, Affiliated Cancer Hospital of Zhengzhou University, Zhengzhou 450008, China ; 10 Department of Thoracic Surgery, Beijing Cancer Hospital, Beijing 100142, China ; 11 Department of Cardiothoracic Surgery, Changhai Hospital, Shanghai 200433, China ; 12 Department of Thoracic Surgery, Liaoning Cancer Hospital, Shenyang 110042, China ; 13 Department of Thoracic Surgery, First Affiliated Hospital of Jilin University, Changchun 130021, China ; 14 Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu 610041, China ; 15 Department of Thoracic Surgery, Huashan Hospital, Fudan University, Shanghai 200032, China ; 16 Department of Esophageal Cancer, Tianjin Cancer Hospital, Tianjin 300060, China ; 17 Department of Thoracic Surgery, Zhejiang Cancer Hospital, Hangzhou 310022, China ; 18 Department of Thoracic Surgery, Jiangxi People's Hospital, Nanchang 330006, China
| | - Liewen Pang
- 1 Department of Thoracic Surgery, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai 200030, China ; 2 Department of Thoracic Surgery, Guangdong Esophageal Cancer Institute, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center of Cancer Medicine, Guangzhou 510060, China ; 3 Department of Thoracic Surgery, Affiliated Hospital of Qingdao University, Qingdao 266001, China ; 4 Department of Thoracic Surgery, Zhongshan Hospital, Fudan University, Shanghai 200032, China ; 5 Department of Endocrinology, Tianjin Medical University General Hospital, Tianjin 300052, China ; 6 Department of Thoracic Surgery, Sichuan Cancer Hospital, Chengdu 610041, China ; 7 Department of Thoracic Surgery, Fujian Medical University Union Hospital, Fuzhou 350001, China ; 8 Department of Thoracic Surgery, First Affiliated Hospital of Anhui Medical University, Hefei 230022, China ; 9 Department of Thoracic Surgery, Affiliated Cancer Hospital of Zhengzhou University, Zhengzhou 450008, China ; 10 Department of Thoracic Surgery, Beijing Cancer Hospital, Beijing 100142, China ; 11 Department of Cardiothoracic Surgery, Changhai Hospital, Shanghai 200433, China ; 12 Department of Thoracic Surgery, Liaoning Cancer Hospital, Shenyang 110042, China ; 13 Department of Thoracic Surgery, First Affiliated Hospital of Jilin University, Changchun 130021, China ; 14 Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu 610041, China ; 15 Department of Thoracic Surgery, Huashan Hospital, Fudan University, Shanghai 200032, China ; 16 Department of Esophageal Cancer, Tianjin Cancer Hospital, Tianjin 300060, China ; 17 Department of Thoracic Surgery, Zhejiang Cancer Hospital, Hangzhou 310022, China ; 18 Department of Thoracic Surgery, Jiangxi People's Hospital, Nanchang 330006, China
| | - Zhentao Yu
- 1 Department of Thoracic Surgery, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai 200030, China ; 2 Department of Thoracic Surgery, Guangdong Esophageal Cancer Institute, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center of Cancer Medicine, Guangzhou 510060, China ; 3 Department of Thoracic Surgery, Affiliated Hospital of Qingdao University, Qingdao 266001, China ; 4 Department of Thoracic Surgery, Zhongshan Hospital, Fudan University, Shanghai 200032, China ; 5 Department of Endocrinology, Tianjin Medical University General Hospital, Tianjin 300052, China ; 6 Department of Thoracic Surgery, Sichuan Cancer Hospital, Chengdu 610041, China ; 7 Department of Thoracic Surgery, Fujian Medical University Union Hospital, Fuzhou 350001, China ; 8 Department of Thoracic Surgery, First Affiliated Hospital of Anhui Medical University, Hefei 230022, China ; 9 Department of Thoracic Surgery, Affiliated Cancer Hospital of Zhengzhou University, Zhengzhou 450008, China ; 10 Department of Thoracic Surgery, Beijing Cancer Hospital, Beijing 100142, China ; 11 Department of Cardiothoracic Surgery, Changhai Hospital, Shanghai 200433, China ; 12 Department of Thoracic Surgery, Liaoning Cancer Hospital, Shenyang 110042, China ; 13 Department of Thoracic Surgery, First Affiliated Hospital of Jilin University, Changchun 130021, China ; 14 Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu 610041, China ; 15 Department of Thoracic Surgery, Huashan Hospital, Fudan University, Shanghai 200032, China ; 16 Department of Esophageal Cancer, Tianjin Cancer Hospital, Tianjin 300060, China ; 17 Department of Thoracic Surgery, Zhejiang Cancer Hospital, Hangzhou 310022, China ; 18 Department of Thoracic Surgery, Jiangxi People's Hospital, Nanchang 330006, China
| | - Xinming Zhou
- 1 Department of Thoracic Surgery, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai 200030, China ; 2 Department of Thoracic Surgery, Guangdong Esophageal Cancer Institute, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center of Cancer Medicine, Guangzhou 510060, China ; 3 Department of Thoracic Surgery, Affiliated Hospital of Qingdao University, Qingdao 266001, China ; 4 Department of Thoracic Surgery, Zhongshan Hospital, Fudan University, Shanghai 200032, China ; 5 Department of Endocrinology, Tianjin Medical University General Hospital, Tianjin 300052, China ; 6 Department of Thoracic Surgery, Sichuan Cancer Hospital, Chengdu 610041, China ; 7 Department of Thoracic Surgery, Fujian Medical University Union Hospital, Fuzhou 350001, China ; 8 Department of Thoracic Surgery, First Affiliated Hospital of Anhui Medical University, Hefei 230022, China ; 9 Department of Thoracic Surgery, Affiliated Cancer Hospital of Zhengzhou University, Zhengzhou 450008, China ; 10 Department of Thoracic Surgery, Beijing Cancer Hospital, Beijing 100142, China ; 11 Department of Cardiothoracic Surgery, Changhai Hospital, Shanghai 200433, China ; 12 Department of Thoracic Surgery, Liaoning Cancer Hospital, Shenyang 110042, China ; 13 Department of Thoracic Surgery, First Affiliated Hospital of Jilin University, Changchun 130021, China ; 14 Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu 610041, China ; 15 Department of Thoracic Surgery, Huashan Hospital, Fudan University, Shanghai 200032, China ; 16 Department of Esophageal Cancer, Tianjin Cancer Hospital, Tianjin 300060, China ; 17 Department of Thoracic Surgery, Zhejiang Cancer Hospital, Hangzhou 310022, China ; 18 Department of Thoracic Surgery, Jiangxi People's Hospital, Nanchang 330006, China
| | - Yangchun Liu
- 1 Department of Thoracic Surgery, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai 200030, China ; 2 Department of Thoracic Surgery, Guangdong Esophageal Cancer Institute, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center of Cancer Medicine, Guangzhou 510060, China ; 3 Department of Thoracic Surgery, Affiliated Hospital of Qingdao University, Qingdao 266001, China ; 4 Department of Thoracic Surgery, Zhongshan Hospital, Fudan University, Shanghai 200032, China ; 5 Department of Endocrinology, Tianjin Medical University General Hospital, Tianjin 300052, China ; 6 Department of Thoracic Surgery, Sichuan Cancer Hospital, Chengdu 610041, China ; 7 Department of Thoracic Surgery, Fujian Medical University Union Hospital, Fuzhou 350001, China ; 8 Department of Thoracic Surgery, First Affiliated Hospital of Anhui Medical University, Hefei 230022, China ; 9 Department of Thoracic Surgery, Affiliated Cancer Hospital of Zhengzhou University, Zhengzhou 450008, China ; 10 Department of Thoracic Surgery, Beijing Cancer Hospital, Beijing 100142, China ; 11 Department of Cardiothoracic Surgery, Changhai Hospital, Shanghai 200433, China ; 12 Department of Thoracic Surgery, Liaoning Cancer Hospital, Shenyang 110042, China ; 13 Department of Thoracic Surgery, First Affiliated Hospital of Jilin University, Changchun 130021, China ; 14 Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu 610041, China ; 15 Department of Thoracic Surgery, Huashan Hospital, Fudan University, Shanghai 200032, China ; 16 Department of Esophageal Cancer, Tianjin Cancer Hospital, Tianjin 300060, China ; 17 Department of Thoracic Surgery, Zhejiang Cancer Hospital, Hangzhou 310022, China ; 18 Department of Thoracic Surgery, Jiangxi People's Hospital, Nanchang 330006, China
| | - Yuan Liu
- 1 Department of Thoracic Surgery, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai 200030, China ; 2 Department of Thoracic Surgery, Guangdong Esophageal Cancer Institute, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center of Cancer Medicine, Guangzhou 510060, China ; 3 Department of Thoracic Surgery, Affiliated Hospital of Qingdao University, Qingdao 266001, China ; 4 Department of Thoracic Surgery, Zhongshan Hospital, Fudan University, Shanghai 200032, China ; 5 Department of Endocrinology, Tianjin Medical University General Hospital, Tianjin 300052, China ; 6 Department of Thoracic Surgery, Sichuan Cancer Hospital, Chengdu 610041, China ; 7 Department of Thoracic Surgery, Fujian Medical University Union Hospital, Fuzhou 350001, China ; 8 Department of Thoracic Surgery, First Affiliated Hospital of Anhui Medical University, Hefei 230022, China ; 9 Department of Thoracic Surgery, Affiliated Cancer Hospital of Zhengzhou University, Zhengzhou 450008, China ; 10 Department of Thoracic Surgery, Beijing Cancer Hospital, Beijing 100142, China ; 11 Department of Cardiothoracic Surgery, Changhai Hospital, Shanghai 200433, China ; 12 Department of Thoracic Surgery, Liaoning Cancer Hospital, Shenyang 110042, China ; 13 Department of Thoracic Surgery, First Affiliated Hospital of Jilin University, Changchun 130021, China ; 14 Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu 610041, China ; 15 Department of Thoracic Surgery, Huashan Hospital, Fudan University, Shanghai 200032, China ; 16 Department of Esophageal Cancer, Tianjin Cancer Hospital, Tianjin 300060, China ; 17 Department of Thoracic Surgery, Zhejiang Cancer Hospital, Hangzhou 310022, China ; 18 Department of Thoracic Surgery, Jiangxi People's Hospital, Nanchang 330006, China
| | - Wentao Fang
- 1 Department of Thoracic Surgery, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai 200030, China ; 2 Department of Thoracic Surgery, Guangdong Esophageal Cancer Institute, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center of Cancer Medicine, Guangzhou 510060, China ; 3 Department of Thoracic Surgery, Affiliated Hospital of Qingdao University, Qingdao 266001, China ; 4 Department of Thoracic Surgery, Zhongshan Hospital, Fudan University, Shanghai 200032, China ; 5 Department of Endocrinology, Tianjin Medical University General Hospital, Tianjin 300052, China ; 6 Department of Thoracic Surgery, Sichuan Cancer Hospital, Chengdu 610041, China ; 7 Department of Thoracic Surgery, Fujian Medical University Union Hospital, Fuzhou 350001, China ; 8 Department of Thoracic Surgery, First Affiliated Hospital of Anhui Medical University, Hefei 230022, China ; 9 Department of Thoracic Surgery, Affiliated Cancer Hospital of Zhengzhou University, Zhengzhou 450008, China ; 10 Department of Thoracic Surgery, Beijing Cancer Hospital, Beijing 100142, China ; 11 Department of Cardiothoracic Surgery, Changhai Hospital, Shanghai 200433, China ; 12 Department of Thoracic Surgery, Liaoning Cancer Hospital, Shenyang 110042, China ; 13 Department of Thoracic Surgery, First Affiliated Hospital of Jilin University, Changchun 130021, China ; 14 Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu 610041, China ; 15 Department of Thoracic Surgery, Huashan Hospital, Fudan University, Shanghai 200032, China ; 16 Department of Esophageal Cancer, Tianjin Cancer Hospital, Tianjin 300060, China ; 17 Department of Thoracic Surgery, Zhejiang Cancer Hospital, Hangzhou 310022, China ; 18 Department of Thoracic Surgery, Jiangxi People's Hospital, Nanchang 330006, China
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Xie A, Tjahjono R, Phan K, Yan TD. Video-assisted thoracoscopic surgery versus open thymectomy for thymoma: a systematic review. Ann Cardiothorac Surg 2015; 4:495-508. [PMID: 26693145 DOI: 10.3978/j.issn.2225-319x.2015.08.01] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
BACKGROUND Video-assisted thoracoscopic surgery (VATS) thymectomy is an increasingly utilized alternative to traditional open approaches for the resection of thymomas. Recent studies have suggested comparable survival and oncological efficacy as well as reduced perioperative morbidity when using the VATS approach. This current systematic review thus aimed to critically evaluate existing evidence for the efficacy and safety of VATS versus open (transsternal or transthoracic) thymectomy for thymomas. METHODS Six electronic databases were searched from their date of inception to April 2015. Relevant studies were identified using specific eligibility criteria and data were extracted and analyzed based on predefined primary and secondary endpoints. RESULTS Fourteen comparative observational studies with a total of 1,061 patients were obtained for qualitative assessment, data extraction and analysis. Five-year overall survival and 10-year recurrence-free survival was similar or higher in patients undergoing VATS compared to open thymectomy. On average, the VATS group also demonstrated reduced intraoperative blood loss (131.8 vs. 340.5 mL), shorter hospital stays (7.0 vs. 9.8 days), and lower rates of postoperative pneumonia (1.9% vs. 4.1%). The mean rate of conversion from VATS to open thymectomy was relatively low (3.1%), while 30-day mortality remained low in both the VATS and open groups (0 vs. 0.3%). CONCLUSIONS The current evidence suggests that VATS thymectomy for thymoma has at least equal if not superior oncological efficacy and survival outcomes, as well as reduced perioperative complications, compared to open surgery. Further adequately powered studies and future randomized trials are required to confirm these findings.
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Affiliation(s)
- Ashleigh Xie
- 1 The Collaborative Research (CORE) Group, Macquarie University, Sydney, Australia ; 2 Department of Cardiothoracic Surgery, Royal Prince Alfred Hospital, Sydney, Australia ; 3 University of Sydney, Sydney, Australia
| | - Richard Tjahjono
- 1 The Collaborative Research (CORE) Group, Macquarie University, Sydney, Australia ; 2 Department of Cardiothoracic Surgery, Royal Prince Alfred Hospital, Sydney, Australia ; 3 University of Sydney, Sydney, Australia
| | - Kevin Phan
- 1 The Collaborative Research (CORE) Group, Macquarie University, Sydney, Australia ; 2 Department of Cardiothoracic Surgery, Royal Prince Alfred Hospital, Sydney, Australia ; 3 University of Sydney, Sydney, Australia
| | - Tristan D Yan
- 1 The Collaborative Research (CORE) Group, Macquarie University, Sydney, Australia ; 2 Department of Cardiothoracic Surgery, Royal Prince Alfred Hospital, Sydney, Australia ; 3 University of Sydney, Sydney, Australia
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Comparison of video-assisted thoracoscopic surgery and median sternotomy approaches for thymic tumor resections at a single institution. Surg Laparosc Endosc Percutan Tech 2015; 25:47-51. [PMID: 24732738 DOI: 10.1097/sle.0000000000000005] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE This study was designed to evaluate the feasibility and safety of video-assisted thoracoscopic surgery (VATS), and to compare the surgical results of VATS with the standard median sternotomy (MS) approach. MATERIALS AND METHODS Between April 2010 and April 2012, the data of 245 patients who underwent thymectomy for thymic tumors were prospectively collected. Among them, 93 patients with clinical stage I-II disease were retrospectively reviewed. RESULTS Resection was planned for VATS in 49 cases, and for MS in 44 cases. During operation, there were 3 conversions to open surgery because of local invasion (conversion to thoracotomy in 1 patient, and sternotomy in 2). No transfusion was required in any patient. There was no significant difference in duration or amount of postoperative chest tube drainage between the 2 groups (P>0.05). Operative time, blood loss during operation, average length of the intensive care unit stay, and length of hospital stay were significantly less in the VATS group than the MS group (P<0.05). There were no major perioperative complications or mortality. No recurrence was detected during a median follow-up of 27 months (range, 12 to 36 mo). CONCLUSIONS VATS thymectomy for early-stage thymic tumors is safe and feasible. In comparison with standard MS, the VATS approach was associated with a shorter intensive care unit stay and hospital stay. Prospective randomized multi-institutional trials with long-term follow-up are needed to compare the oncological outcomes.
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Chao YK, Liu YH, Hsieh MJ, Wu YC, Chen TP, Lu MS, Lu HI, Liu HP. Long-Term Outcomes After Thoracoscopic Resection of Stage I and II Thymoma: A Propensity-Matched Study. Ann Surg Oncol 2014; 22:1371-6. [DOI: 10.1245/s10434-014-4068-9] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2013] [Indexed: 11/18/2022]
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Bae MK, Lee SK, Kim HY, Park SY, Park IK, Kim DJ, Chung KY. Recurrence after thymoma resection according to the extent of the resection. J Cardiothorac Surg 2014; 9:51. [PMID: 24646138 PMCID: PMC3994658 DOI: 10.1186/1749-8090-9-51] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2013] [Accepted: 03/11/2014] [Indexed: 11/21/2022] Open
Abstract
Background Complete resection of the thymus is considered appropriate for a thymoma resection because any remaining thymic tissue can lead to local recurrence. However, there are few studies concerning the extent of thymus resection. Therefore, we conducted a retrospective study to investigate whether recurrence following thymoma resection correlated to the extent of resection. Methods Between 1986 and 2011, a total of 491 patients underwent resection of thymic epithelial tumors with curative intent. Of those, we excluded patients with an undetermined World Health Organization (WHO) histologic type, patients with type C thymoma, and patients who underwent incomplete resection (n = 21). The remaining 342 patients were reviewed retrospectively and compared recurrence according to the extent of resection. Results Extended thymectomy was performed in 239 patients (69.9%) and limited thymectomy was performed 103 patients (30.1%). In the extended thymectomy group, 29 recurrences occurred, and in the limited thymectomy group, 10 recurrences occurred. Comparing rates of freedom from recurrence between two groups, there was no significant statistical difference in total recurrence (p =0.472) or local recurrence (p =0.798). After matching patients by stage and tumor size, there was no significant difference in freedom from recurrence between the two groups (p = 0.162). Additionally, after adjusting for histologic type and MG, there was also no significant difference (p = 0.125) between groups. Conclusions No difference in the rate of recurrence was observed in patients following limited thymectomy compared with extended thymectomy.
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Affiliation(s)
| | | | | | | | | | | | - Kyung Young Chung
- Department of Thoracic and Cardiovascular Surgery, Yonsei University College of Medicine, Seoul, Korea.
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Thoracoscopic versus transsternal resection for early stage thymoma: long-term outcomes. Surg Today 2014; 44:2275-80. [DOI: 10.1007/s00595-013-0829-5] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2013] [Accepted: 12/10/2013] [Indexed: 11/29/2022]
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Nakagawa K, Asamura H, Sakurai H, Watanabe SI, Tsuta K. Does the mode of surgical resection affect the prognosis/recurrence in patients with thymoma? J Surg Oncol 2013; 109:179-83. [DOI: 10.1002/jso.23499] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2013] [Accepted: 10/23/2013] [Indexed: 11/08/2022]
Affiliation(s)
- Kazuo Nakagawa
- Division of Thoracic Surgery; National Cancer Center Hospital; Tokyo Japan
| | - Hisao Asamura
- Division of Thoracic Surgery; National Cancer Center Hospital; Tokyo Japan
| | - Hiroyuki Sakurai
- Division of Thoracic Surgery; National Cancer Center Hospital; Tokyo Japan
| | - Shun-Ichi Watanabe
- Division of Thoracic Surgery; National Cancer Center Hospital; Tokyo Japan
| | - Koji Tsuta
- Division of Pathology; National Cancer Center Hospital; Tokyo Japan
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Clinicopathological analysis of small-sized anterior mediastinal tumors. Surg Today 2013; 44:1817-22. [DOI: 10.1007/s00595-013-0727-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2013] [Accepted: 08/01/2013] [Indexed: 10/26/2022]
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Yokota K, Tateyama H, Yano M, Moriyama S, Hikosaka Y, Okuda K, Shitara M, Okumura M, Yokoi K, Fujii Y. Clinicopathological analysis of small-sized thymoma with podoplanin and Ki 67 expression analysis. Mol Clin Oncol 2013; 1:88-92. [PMID: 24649128 DOI: 10.3892/mco.2012.2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2012] [Accepted: 06/06/2012] [Indexed: 11/06/2022] Open
Abstract
Thymoma is the most common tumor of the anterior mediastinum for which surgical resection is currently the primary form of treatment. An increase in the incidence of a small-sized (≤3 cm) thymoma (SST) has recently been noted. Clinicopathological factors and prognosis of SST have not been reported previously. In this study, the clinicopathological data of 21 SST patients were reviewed and podoplanin and Ki67 immunohistochemistry were assessed to determine the biological behavior of SSTs. Pathological diagnosis of SSTs revealed the following types: A (n=1), AB (n=8), B1 (n=5), B2 (n=6) and B3 (n=1). The Masaoka-Koga stages of 21 thymoma patients were I (n=16), II (n=3), III (n=1) and IVb (n=1). In the case of the stage IVb thymoma, phrenic nerve, mediastinal pleura invasion and anterior mediastinal lymph node metastasis were observed. The Ki67 labeling index of this stage IVb was found to be 3.2. This case was also positive for podoplanin and was one of the only 2 cases that were positive for podoplanin. This patient succumbed to thymoma. Advanced stage thymomas are possibly included in SSTs although the majority of SSTs are classified into early stages of disease. Findings of this study suggest that podoplanin analyzed by immunohistochemistry may be useful to determine the malignant behavior of SSTs.
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Affiliation(s)
- Keisuke Yokota
- Department of Oncology, Immunology and Surgery, Nagoya City University Graduate School of Medical Sciences, Nagoya
| | | | - Motoki Yano
- Department of Oncology, Immunology and Surgery, Nagoya City University Graduate School of Medical Sciences, Nagoya
| | - Satoru Moriyama
- Department of Oncology, Immunology and Surgery, Nagoya City University Graduate School of Medical Sciences, Nagoya
| | - Yu Hikosaka
- Department of Oncology, Immunology and Surgery, Nagoya City University Graduate School of Medical Sciences, Nagoya
| | - Katsuhiro Okuda
- Department of Oncology, Immunology and Surgery, Nagoya City University Graduate School of Medical Sciences, Nagoya
| | - Masayuki Shitara
- Department of Oncology, Immunology and Surgery, Nagoya City University Graduate School of Medical Sciences, Nagoya
| | - Meinoshin Okumura
- Department of General Thoracic Surgery, Osaka University Graduate School of Medicine, Osaka
| | - Kohei Yokoi
- Division of Thoracic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Yoshitaka Fujii
- Department of Oncology, Immunology and Surgery, Nagoya City University Graduate School of Medical Sciences, Nagoya
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Reply to Anile et al. Lung Cancer 2010. [DOI: 10.1016/j.lungcan.2010.06.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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Anile M, Diso D, Vitolo D, Rendina EA, Venuta F. Surgical treatment of early stage thymoma. Lung Cancer 2010; 70:116; author reply 117. [PMID: 20674070 DOI: 10.1016/j.lungcan.2010.06.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2010] [Accepted: 06/19/2010] [Indexed: 10/19/2022]
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