PDF (5 MB) - Jurnalul de Chirurgie

Lateral & paracardiac thymoma 177Jurnalul de Chirurgie (Iaşi), 2013, Vol. 9, Nr. 2patient showed complete regression of thethymoma and associated symptoms withoutradiological recurrence after 12 months[12,13].The initial stage of treatment in mostcases of the thymoma is surgery. Surgicalresection is the treatment of choice for mostneoplasms arising in the mediastinum. Incases of benign lesions the tumor completeexcision is generally sufficient. Thymoma isone of the exceptions from this principlebecause total thymectomy is indicated for allbenign or malignant thymoma; the tumor hasto be resected without “breaking” thecapsule. Surgical excision provides tissue forhistological examinations and informationon the invasive character of the tumor,which is important to determine the need foran adjuvant therapy. In cases of malignantthymomas, a complete R 0 resection shouldbe performed. Pericardium, pleura, lungsegments, sternum, ribs and diaphragm canbe resected to achieve R 0 resection in thecases with invasive thymomas [16].Furthermore brachiocephalic vein and evensuperior vena cava can be resected; thevascular reconstruction is usually performedusing prosthetic grafts [17,18].The surgery approach is the mid linesternotomy or posterolateral thoracotomy; ininvasive thymoma for multivisceralresections the transverse sternotomyextended in 4 th intercostals space could benecessary. The video assisted resection isaccepted for stage I disease [19].A single-institution retrospective studywas conducted involving 5 patients withstage IVA treated with pleurapneumonectomy[20]. The median survivalwas 86 months, and the Kaplan-Meiersurvival was 75% at 5 years and 50% at 10years. There were no operative mortalities inthis study. It has been suggested that, inselected patients, this approach, the completeresection after neoadjuvant chemotherapy,may be promising [20].A multidisciplinary approach to thetreatment for inoperable thymoma was alsodeveloped. In a study conducted by the MDAnderson Cancer Center, a regimenconsisting of the induction chemotherapy,surgical resection, postoperativeradiotherapy, and consolidationchemotherapy (e.g. 3 cures ofcyclophosphamide, doxorubicin, cisplatin,and prednisone) was tested. [14,15]CONCLUSIONSThe prognosis of thymoma depends ontumor histology. The presented cases wereMasaoka I stage tumors. The tumors werecompletely removed and the outcome of thepatients was very good with no recurrencesfor up to 14 years. The lateral approachprovides good access and facilitates theresection.CONFLICT OF INTERESTSNone to declareACKNOWLEDGEMENTThis paper is partly supported by theSectorial Operational Programme HumanResources Development (SOP HRD),financed from the European Social Fund andby the Romanian Government under thecontract number POSDRU 80641.REFERENCES1. Detterbeck FC, Parsons AM. Thymic tumors.Ann Thorac Surg. 2004; 77(5): 1860-1869.2. Mullen B, Richardson JD. Primary anteriormediastinal tumors in children and adults. AnnThorac Surg. 1986; 42(3): 338-345.3. Falkson CB, Bezjak A, Darling G, et al. Themanagement of thymoma: a systematic reviewand practice guideline. J Thorac Oncol. 2009;4(7): 911-919.4. Kondo K, Yoshizawa K, Tsuyuguchi M, et al.WHO histologic classification is a prognosticindicator in thymoma. Ann Thorac Surg. 2004;77(4): 1183-1188.5. Fornasiero A, Daniele O, Ghiotto C, et al.Chemotherapy for invasive thymoma. A 13-year experience. Cancer. 1991; 68(1): 30-33.6. Konstantinov IE, Saxena P, Koniuszko M, etal. Superior vena cava obstruction by tumorthrombus in invasive thymoma: diagnosis andsurgical management. Heart Lung Circ. 2007;16(6):462-464.7. Blumberg D, Port JL, Weksler B, et al.Thymoma: a multivariate analysis of factorspredicting survival. Ann Thorac Surg. 1995;60(4): 908-913; discussion 914.