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Kaminski HJ, Kusner LL, Cutter GR, Le Panse R, Wright CD, Perry Y, Wolfe GI. Does Surgical Removal of the Thymus Have Deleterious Consequences? Neurology 2024; 102:e209482. [PMID: 38781559 PMCID: PMC11226319 DOI: 10.1212/wnl.0000000000209482] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2024] [Accepted: 03/28/2024] [Indexed: 05/25/2024] Open
Abstract
The role of immunosenescence, particularly the natural process of thymic involution during aging, is increasingly acknowledged as a factor contributing to the development of autoimmune diseases and cancer. Recently, a concern has been raised about deleterious consequences of the surgical removal of thymic tissue, including for patients who undergo thymectomy for myasthenia gravis (MG) or resection of a thymoma. This review adopts a multidisciplinary approach to scrutinize the evidence concerning the long-term risks of cancer and autoimmunity postthymectomy. We conclude that for patients with acetylcholine receptor antibody-positive MG and those diagnosed with thymoma, the removal of the thymus offers prominent benefits that well outweigh the potential risks. However, incidental removal of thymic tissue during other thoracic surgeries should be minimized whenever feasible.
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Affiliation(s)
- Henry J Kaminski
- From the Department of Neurology & Rehabilitation Medicine (H.J.K.), George Washington University, DC; Department of Pharmacology & Physiology (L.L.K.), and Department of Biostatistics (G.R.C.), University of Alabama at Birmingham; INSERM (R.L.P.), Institute of Myology, Center of Research in Myology, Sorbonne University, Paris, France; Department of Surgery (C.D.W.), Harvard Medical School, Boston, MA; and Department of Surgery (Y.P.), and Department of Neurology (G.I.W.), Jacobs School of Medicine and Biomedical Sciences, University at Buffalo/SUNY, NY
| | - Linda L Kusner
- From the Department of Neurology & Rehabilitation Medicine (H.J.K.), George Washington University, DC; Department of Pharmacology & Physiology (L.L.K.), and Department of Biostatistics (G.R.C.), University of Alabama at Birmingham; INSERM (R.L.P.), Institute of Myology, Center of Research in Myology, Sorbonne University, Paris, France; Department of Surgery (C.D.W.), Harvard Medical School, Boston, MA; and Department of Surgery (Y.P.), and Department of Neurology (G.I.W.), Jacobs School of Medicine and Biomedical Sciences, University at Buffalo/SUNY, NY
| | - Gary R Cutter
- From the Department of Neurology & Rehabilitation Medicine (H.J.K.), George Washington University, DC; Department of Pharmacology & Physiology (L.L.K.), and Department of Biostatistics (G.R.C.), University of Alabama at Birmingham; INSERM (R.L.P.), Institute of Myology, Center of Research in Myology, Sorbonne University, Paris, France; Department of Surgery (C.D.W.), Harvard Medical School, Boston, MA; and Department of Surgery (Y.P.), and Department of Neurology (G.I.W.), Jacobs School of Medicine and Biomedical Sciences, University at Buffalo/SUNY, NY
| | - Rozen Le Panse
- From the Department of Neurology & Rehabilitation Medicine (H.J.K.), George Washington University, DC; Department of Pharmacology & Physiology (L.L.K.), and Department of Biostatistics (G.R.C.), University of Alabama at Birmingham; INSERM (R.L.P.), Institute of Myology, Center of Research in Myology, Sorbonne University, Paris, France; Department of Surgery (C.D.W.), Harvard Medical School, Boston, MA; and Department of Surgery (Y.P.), and Department of Neurology (G.I.W.), Jacobs School of Medicine and Biomedical Sciences, University at Buffalo/SUNY, NY
| | - Cameron D Wright
- From the Department of Neurology & Rehabilitation Medicine (H.J.K.), George Washington University, DC; Department of Pharmacology & Physiology (L.L.K.), and Department of Biostatistics (G.R.C.), University of Alabama at Birmingham; INSERM (R.L.P.), Institute of Myology, Center of Research in Myology, Sorbonne University, Paris, France; Department of Surgery (C.D.W.), Harvard Medical School, Boston, MA; and Department of Surgery (Y.P.), and Department of Neurology (G.I.W.), Jacobs School of Medicine and Biomedical Sciences, University at Buffalo/SUNY, NY
| | - Yaron Perry
- From the Department of Neurology & Rehabilitation Medicine (H.J.K.), George Washington University, DC; Department of Pharmacology & Physiology (L.L.K.), and Department of Biostatistics (G.R.C.), University of Alabama at Birmingham; INSERM (R.L.P.), Institute of Myology, Center of Research in Myology, Sorbonne University, Paris, France; Department of Surgery (C.D.W.), Harvard Medical School, Boston, MA; and Department of Surgery (Y.P.), and Department of Neurology (G.I.W.), Jacobs School of Medicine and Biomedical Sciences, University at Buffalo/SUNY, NY
| | - Gil I Wolfe
- From the Department of Neurology & Rehabilitation Medicine (H.J.K.), George Washington University, DC; Department of Pharmacology & Physiology (L.L.K.), and Department of Biostatistics (G.R.C.), University of Alabama at Birmingham; INSERM (R.L.P.), Institute of Myology, Center of Research in Myology, Sorbonne University, Paris, France; Department of Surgery (C.D.W.), Harvard Medical School, Boston, MA; and Department of Surgery (Y.P.), and Department of Neurology (G.I.W.), Jacobs School of Medicine and Biomedical Sciences, University at Buffalo/SUNY, NY
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Petroncini M, Solli P, Brandolini J, Lai G, Antonacci F, Garelli E, Kawamukai K, Forti Parri SN, Bonfanti B, Dolci G, Bertoglio P. Early Postoperative Results after Thymectomy for Thymic Cancer: A Single-Institution Experience. World J Surg 2023; 47:1978-1985. [PMID: 37079104 PMCID: PMC10310559 DOI: 10.1007/s00268-023-06996-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/26/2023] [Indexed: 04/21/2023]
Abstract
BACKGROUND Surgery for thymic cancers is considered the key of curative treatment. Preoperative patients' characteristics and intraoperative features might influence postoperative outcome. We aim to verify short-term outcomes and possible risk factors for complications after thymectomy. METHODS We retrospectively investigated patients undergoing surgery for thymoma or thymic carcinoma in the period between January 1, 2008, and December 31, 2021, in our department. Preoperative features, surgical technique (open, bilateral VATS, RATS), intraoperative characteristics and incidence of postoperative complications (PC) were analyzed. RESULTS We included in the study 138 patients. Open surgery was performed in 76 patients (55.1%), in 36 VATS (26.1%) and in 26 RATS (36.1%). Resection of one or more adjacent organs due to neoplastic infiltration was required in 25 patients. PC appeared in 25 patients (52% Clavien-Dindo grade I, 12% grade IVa). Open surgery had a higher incidence of PC (p < 0.001), longer postoperative in-hospital stay (p = 0.045) and larger neoplasm (p = 0.006). PC were significant related to pulmonary resection (p = 0.006), phrenic nerve resection (p = 0.029), resection of more than one organ (p = 0.009) and open surgery (p = 0.001), but only extended surgery of more organs was confirmed as independent prognostic factor for PC (p = 0.0013). Patients with preoperative myasthenia symptoms have a trend toward stage IVa complications (p = 0.065). No differences were observed between outcomes of VATS and RATS. CONCLUSIONS Extended resections are related to a higher incidence of PC, while VATS and RATS guarantee a lower incidence of PC and shorter postoperative stay even in patients that require extended resections. Symptomatic myasthenia patients might have a higher risk toward more severe complications.
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Affiliation(s)
- Matteo Petroncini
- Division of Thoracic Surgery, IRCCS Azienda Ospedaliero Universitaria Di Bologna, Via Albertoni 15, 40138, Bologna, Italy
| | - Piergiorgio Solli
- Division of Thoracic Surgery, IRCCS Azienda Ospedaliero Universitaria Di Bologna, Via Albertoni 15, 40138, Bologna, Italy
| | - Jury Brandolini
- Division of Thoracic Surgery, IRCCS Azienda Ospedaliero Universitaria Di Bologna, Via Albertoni 15, 40138, Bologna, Italy
| | - Giulia Lai
- Division of Thoracic Surgery, IRCCS Azienda Ospedaliero Universitaria Di Bologna, Via Albertoni 15, 40138, Bologna, Italy
| | - Filippo Antonacci
- Division of Thoracic Surgery, IRCCS Azienda Ospedaliero Universitaria Di Bologna, Via Albertoni 15, 40138, Bologna, Italy
| | - Elena Garelli
- Division of Thoracic Surgery, IRCCS Azienda Ospedaliero Universitaria Di Bologna, Via Albertoni 15, 40138, Bologna, Italy
| | - Kenji Kawamukai
- Division of Thoracic Surgery, IRCCS Azienda Ospedaliero Universitaria Di Bologna, Via Albertoni 15, 40138, Bologna, Italy
| | - Sergio Nicola Forti Parri
- Division of Thoracic Surgery, IRCCS Azienda Ospedaliero Universitaria Di Bologna, Via Albertoni 15, 40138, Bologna, Italy
| | - Barbara Bonfanti
- Division of Thoracic Surgery, IRCCS Azienda Ospedaliero Universitaria Di Bologna, Via Albertoni 15, 40138, Bologna, Italy
| | - Giampiero Dolci
- Division of Thoracic Surgery, IRCCS Azienda Ospedaliero Universitaria Di Bologna, Via Albertoni 15, 40138, Bologna, Italy
| | - Pietro Bertoglio
- Division of Thoracic Surgery, IRCCS Azienda Ospedaliero Universitaria Di Bologna, Via Albertoni 15, 40138, Bologna, Italy.
- Alma Mater Studiorum, Università di Bologna, Bologna, Italy.
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Inra M, Lazzaro R. Commentary: Great Outcomes Associated With Robotic Thymectomy -Thank You Very Much Mr Robot. Semin Thorac Cardiovasc Surg 2023; 35:200-201. [PMID: 34906700 DOI: 10.1053/j.semtcvs.2021.12.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2021] [Accepted: 12/07/2021] [Indexed: 11/11/2022]
Affiliation(s)
- Matthew Inra
- Department of Cardiovascular and Thoracic Surgery, Northwell Health Lenox Hill Hospital, New York, New York; Donald and Barbara Zucker School of Medicine at Hofstra Northwell, Hempstead, New York
| | - Richard Lazzaro
- Department of Cardiovascular and Thoracic Surgery, Northwell Health Lenox Hill Hospital, New York, New York; Donald and Barbara Zucker School of Medicine at Hofstra Northwell, Hempstead, New York
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