Salvage surgery for stage IVa thymic carcinoma combined with aortic arch resection - case report

Perioperative management and postoperative outcomes of locally advanced thymic epithelial tumors: a narrative review

Background and Objective

Thymic epithelial tumors (TETs) are frequently diagnosed at an advanced stage, highlighting the importance of understanding the treatment strategies for these cases. Surgical intervention after chemotherapy or chemoradiotherapy presents specific challenges and underscores the crucial role of perioperative management. This study aimed to explore the perioperative management and postoperative outcomes in patients with locally advanced TETs.

Methods

Relevant studies published between 2000 and 2022 were identified through PubMed searches using a combination of the following terms: "Locally advanced TETs", "Thymoma", "Thymic cancer", "Surgery", "Induction therapy", and "Postoperative outcomes". We analyzed available data to describe the perioperative management and postoperative outcomes of locally advanced TETs.

Key Content and Findings

Surgical outcomes after induction therapy for locally advanced TETs were analyzed for 18 references (total n=646) between 2000 and 2022. The primary objective of induction therapy for locally advanced TETs is complete tumor resection. In recent years, many medical centers have adopted systemic chemotherapy and chemoradiation for the treatment of thymoma and thymic carcinoma, respectively. During surgical intervention, resecting the surrounding organs, such as the lungs, pericardium, and phrenic nerves, is a common practice. Additionally, there may be cases wherein vascular resection of the superior vena cava (SVC) and innominate veins is necessary. Techniques and strategies for revascularization without complications are crucial in these situations. The incidence of postoperative complications varied significantly, ranging from 4.8% to 42%. However, perioperative mortality is typically reported to be approximately 0%, with only two reports showing mortality rates of 1.8% and 9.0%.

Conclusions

The short-term postoperative outcomes of surgical treatment following induction therapy for locally advanced TETs were generally deemed acceptable. However, incomplete resection may occur, particularly when the tumor invades the pulmonary artery or aorta. Hence, careful evaluation the indications for surgery is crucial, considering the patient's overall condition and treatment response.

Outcomes of extended surgical resections for locally advanced thymic malignancies: a narrative review

BACKGROUND AND OBJECTIVE

Thymic malignancies represent the most common anterior mediastinal neoplasms, as well as rare and challenging tumors. Surgery is the cornerstone in the treatment of thymic malignancies, although a multidisciplinary approach is mandatory, for both, locally advanced or metastatic disease. In our narrative review, we explored the recent literature to investigate clinical and radiological assessment, multimodality approach and outcomes of locally advanced thymic tumors. More than one-third of patients affected by an anterior mediastinal mass are asymptomatic at diagnosis. In case of locally advanced thymoma, symptoms are related to compression or invasion of adjacent structures, such as the superior vena cava (SVC), innominate veins and pericardium. Paraneoplastic syndromes, such as myasthenia gravis (MG), are related to release of antibodies, hormones and cytokines.

METHODS

Diagnostic methods must be chosen accurately to avoid unnecessary surgical resections, to define the best strategy of care, and to plan the surgical strategy. Therefore, each case must be evaluated in a multidisciplinary context, where surgery plays an essential role.

KEY CONTENT AND FINDINGS

In this narrative review, we describe indications and surgical techniques for the treatment of locally advanced thymoma; focusing on oncological outcomes after different approaches.

CONCLUSIONS

In conclusion, aggressive surgery is always indicated, when possible, and when a complete resection can be planned, yet, the multidisciplinary approach is mandatory, in case of both locally or metastatic advanced disease.