Thymoma is a rare neoplasm usually with an indolent growth pattern, however, local invasion and/or metastases may occur. The association with several paraneoplastic syndromes, especially myasthenia gravis, is noteworthy. Surgery has been the standard of care for early stage disease with high cure rates anticipated. The most important prognostic factors after resection are Masaoka stage, World Health Organization (WHO) histology, complete resection status and size. Multimodality therapy can result in long-term disease-free survival for patients presenting with locally advanced disease. Thymomas are sensitive to both chemotherapy and radiation therapy and are utilized with good effects in unresectable patients.
"Distinction between histological subtypes has important clinical implications. Thymomas are low-grade malignant tumours that tend to invade surrounding organs and rarely give distant metastasis . Thymic carcinomas are highly aggressive , may arise from malignant transformation of a pre-existing thymoma  and have poor prognosis due to the local invasiveness and the risk of metastasis . "
"First, when limited thymectomy is performed, one issue is how to guarantee a sufficient margin while achieving complete resection. Transcapsular perithymic invasion can be subtle and is often not grossly appreciable by the surgeon peri-operatively . Thus, even when resection is performed to include the surrounding thymus and fatty tissue, it is unclear how much tissue in addition to thymoma should be resected to ensure complete resection. "
[Show abstract][Hide abstract] ABSTRACT: Complete resection of the thymus is considered appropriate for a thymoma resection because any remaining thymic tissue can lead to local recurrence. However, there are few studies concerning the extent of thymus resection. Therefore, we conducted a retrospective study to investigate whether recurrence following thymoma resection correlated to the extent of resection.
Between 1986 and 2011, a total of 491 patients underwent resection of thymic epithelial tumors with curative intent. Of those, we excluded patients with an undetermined World Health Organization (WHO) histologic type, patients with type C thymoma, and patients who underwent incomplete resection (n = 21). The remaining 342 patients were reviewed retrospectively and compared recurrence according to the extent of resection.
Extended thymectomy was performed in 239 patients (69.9%) and limited thymectomy was performed 103 patients (30.1%). In the extended thymectomy group, 29 recurrences occurred, and in the limited thymectomy group, 10 recurrences occurred.Comparing rates of freedom from recurrence between two groups, there was no significant statistical difference in total recurrence (p =0.472) or local recurrence (p =0.798). After matching patients by stage and tumor size, there was no significant difference in freedom from recurrence between the two groups (p = 0.162). Additionally, after adjusting for histologic type and MG, there was also no significant difference (p = 0.125) between groups.
No difference in the rate of recurrence was observed in patients following limited thymectomy compared with extended thymectomy.
Journal of Cardiothoracic Surgery 03/2014; 9(1):51. DOI:10.1186/1749-8090-9-51 · 1.03 Impact Factor
"Wright12 suggested that a tumor size of 8 cm or larger was an independent risk factor of recurrence, and that large masses in which invasiveness is not clearly observable on CT are likely to be treated as stage III tumors. Our results also showed that a tumor size of 8 cm or larger was significantly associated with recurrence. "
[Show abstract][Hide abstract] ABSTRACT: Purpose
Recurrence rate is considered a better measure of clinical outcomes after thymoma resection than overall survival due to the indolent behavior of thymomas. This study was designed to determine predictors of recurrence after thymoma resection.
Materials and Methods
A single-institution, retrospective study was performed, including 305 patients who had undergone thymoma resection between 1986 and 2009.
Among 305 patients, recurrence was observed in 41 patients (13.4%). The recurrence rates were 0% (0/19), 6.3% (4/63), 4.2% (2/48), 18.6% (11/59) and 20.7% (24/116) for type A, AB, B1, B2 and B3 tumors, respectively. The recurrence rate according to Masaoka stage was 6.1% (8/132), 11.4% (13/114), 26.8% (11/41) and 50.0% (9/18) for stages I, II, III and IV, respectively. After univariate analysis, completeness of resection (R0 versus R1), World Health Organization (WHO) histologic type (A, AB, B1 versus B2, B3), Masaoka stage, and size of tumor (<8 cm versus ≥8 cm) demonstrated significant differences with freedom from recurrence. Upon multivariate analysis, Masaoka stage was the only independent predictor of recurrence.
WHO histologic type, Masaoka stage, and size of tumor were associated with recurrence. Particularly, Masaoka stage was the only independent predictor of recurrence after thymoma resection.
Yonsei medical journal 07/2013; 54(4):875-882. DOI:10.3349/ymj.2013.54.4.875 · 1.29 Impact Factor
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