Video assisted thoracic surgery (VATS) for recurrent thymoma

Open redo thymectomy for a large recurrent thymoma in a patient with myasthenia gravis: a case report

Thoracoscopic and robotic approaches are becoming increasingly popular for thymoma surgery. Yet open thymectomy must still be mastered today, as it may be the only viable option in challenging cases. In this study, we report a case of an extended local recurrence of myasthenia gravis associated thymoma and a history of previous sternotomy. The mediastinal mass infiltrated the left upper lobe of the lung, the pericardium, and presumably the aortic arch. Although the standard for thymoma resection at our institution is the robotic approach, we performed primary open redo thymectomy in standby of cardiopulmonary bypass in this case. Intraoperatively, bleeding from the aortic arch occurred, which was promptly controlled due to the open approach and due to immediate availability of cardiopulmonary bypass. The patient was transferred to the normal ward on the first postoperative day, was treated according to fast-track principles and recovered well. The pathology revealed a WHO B2:B1 thymoma with negative resection margins. Thymectomy is recommended as the principal treatment for thymoma and is also advised in the case of recurrence. However, there is no evidence regarding the optimal surgical approach. Our case indicates that in the era of minimally invasive thymectomy, the decision to conduct open surgery is wise when the risk of serious bleeding is anticipated or adherence to oncologic principles is challenged by tumor size or growth pattern.

Comparing the safety and efficacy of thoracoscopic surgery and thoracotomy for thymoma: a systematic review and meta-analysis

BACKGROUND

To systematically evaluate the efficacy of thoracoscopic surgery compared to traditional thoracotomy for thymic tumors.

METHODS

We performed a literature search on computer of the PubMed, Embase, Cochrane Library, Web of Science, China Biology Medicine (CBM), WanFang, and China national knowledge infrastructure (CNKI) databases from the date of establishment of the database to April 2021, and retrieved randomized controlled trials (RCTs) and cohort studies on thoracoscopic surgery and thoracotomy with conventional open thoracic surgery. After independent screening of the literature by two assessors, the relevant data was extracted and the risk of bias in the included studies was evaluated. RevMan 5.3 software was used to perform the analysis.

RESULTS

Five RCTs and eight cohort studies were ultimately included, with a total of 1,093 patients. The results of meta-analysis showed that compared with traditional thoracoscopic surgery, thoracoscopy had shorter surgery duration (OR =22.2, 95% CI: -31.92, -12.52, P<0.00001), ICU stay (OR =0.29, 95% CI: 0.20, 0.42, P<0.00001), and hospitalization time (OR =0.531, 95% CI: 0.41, 0.69, P<0.00001) times, as well as reduced chest tube drainage time (OR =0.49, 95% CI: 0.33, 0.73, P=0.0004), less intraoperative bleeding (OR =43.27, 95% CI: -50.94, -35.60, P<0.00001), and a lower incidence of postoperative complications (OR =0.19, 95% CI: 0.11, 0.34, P<0.00001). However, the tumor recurrence rate was not significantly different between the two procedures (OR =0.69, 95% CI: 0.32, 1.48, P=0.34).

DISCUSSION

The existing evidence suggests that thoracoscopic surgery has shorter surgery duration, ICU stay time, hospitalization time, reduced thoracic tube drainage, less intraoperative bleeding, and a lower incidence of postoperative complications compared with traditional thoracotomy surgery. However, due to the poor quality of the included research, more high-quality studies need to be conducted to verify the above conclusions.

[Treatment of Recurrent Thymoma]

胸腺瘤是一种具有恶性潜能的疾病，完整切除后的复发率为10%-30%。复发性胸腺瘤的治疗策略及标准未达成一致，治疗方式包括再次手术治疗、化疗、放疗、靶向治疗及免疫治疗等，至今存在着争议。在这篇综述中，通过回顾既往的文献，总结了复发性胸腺瘤的不同治疗方法的适应证、疗效以及预后，以期给复发性胸腺瘤治疗标准的制定提供一些参考。

Third distant recurrence of benign thymoma in a patient with myasthenia gravis

Myasthenia gravis (MG) is an autoimmune disease where antibodies attack the presynaptic terminals at the neuromuscular junction causing progressive weakness. Associated with thymomas, resection can improve symptoms. A 29-year-old woman with MG who underwent two previous thymectomies, at ages 11 and 15 presented 14 years later with recurrent MG symptoms and an anterior mediastinal mass. Robotic-assisted thoracoscopic excision of the mediastinal mass was performed without complications. She recovered well and had improvement of her MG symptoms. Thymectomy can significantly improve symptoms in MG even for patients who do not have a thymoma. Reports of distant benign thymoma recurrence are rare. MG patients require continued monitoring and vigilance, even after thymectomy. Benign thymomas can recur even after significant time intervals, and utilisation of the robotic platform for recurrent thymoma excision is safe, even following two sternotomies. Patient symptoms improve with redo thymectomy.