Extended Thymectomy Including Lung-Sparing Pleurectomy for the Treatment of Thymic Malignancies with Pleural Spread

Abstract

Objective To investigate the outcome of extended thymectomy including lung-sparing pleurectomy (extended surgery) in primary clinically advanced Masaoka-Koga stage IVa thymic malignancies.

Patients and Methods Thirteen patients diagnosed with thymic malignancies at primary clinically Masaoka-Koga stage IVa were retrospectively analyzed between January 2000 and December 2012 at the Department of Thoracic Surgery, Dr. Horst Schmidt Klinik, Wiesbaden. Chi-square tests, Kaplan-Meier analyses, log-rank tests, and Cox regression analyses were used to estimate survival and determine prognosticators of survival.

Results World Health Organization (WHO) classification were type C (n = 6), type B3 (n = 5), and type AB (n = 2), respectively. Nine patients underwent extended surgery. Morbidity was observed in three patients (33%). Mortality occurred in one patient. Four patients (31%) were unresectable at the time of surgery and underwent chemoradiation. Despite the clinically staging, five patients had lymph node metastases and thus pathologic Masaoka-Koga stage IVb. Median survival (MS) for all patients was 49 months. Extended surgery (MS 89 months) was associated with prolonged survival compared with patients who underwent only chemoradiation (MS 5 months). Stage migration due to lymph node metastases, WHO-classification type C, and T3/4-status were associated with inferior survival in the univariate analysis. Extended surgery remained the only independent significant prognosticator in the multivariate analysis.

Conclusion Extended surgery within multimodality treatments might offer survival advantage for advanced thymic malignancies with pleural spread. Patients with lymph node metastases and WHO classification type C might be at high risk of unresectability.

Keywords

thymoma - thymic cancer - surgery - pleurectomy

Note

This article was presented in part at the 19th European Conference on General Thoracic Surgery June 5–8, 2011, Marseille (France); 20th Conference on German Society of General Thoracic Surgery (DGT), September 22–24, 2011, Düsseldorf-Kaiserswerth (Germany); and 129th Conference of the German Society of Surgery (DGCH), April 24–27, 2012, Berlin (Germany).

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