Surgical Treatment of Stage I and II Thymus Epithelial Tumors
- Authors: Epifantsev E.A.1, Gritsun V.Y.1, Keshvedinova A.A.1, Smirnov A.V.1, Ivanov Y.V.1,2
-
Affiliations:
- Federal Research and Clinical Center of Specialized Medical Care and Medical Technologies
- Central Research Institute of Tuberculosis
- Issue: Vol 14, No 3 (2023)
- Pages: 103-111
- Section: Reviews
- URL: https://journals.rcsi.science/clinpractice/article/view/253938
- DOI: https://doi.org/10.17816/clinpract546144
- ID: 253938
Cite item
Full Text
Abstract
Thymic epithelial tumors are the most common tumors of the anterior mediastinum, with an incidence of 0.18 per 100,000 population. Here, we present a review of the national and foreign literature on the surgical treatment of stage I and II thymic epithelial tumors. The Medline (PubMed) and Russian Science Citation Index (eLibrary) databases were used as search engines. The focus of the review is the problem of choosing the optimal minimally invasive surgical approach for thymectomy, and the need for lymph node dissection for thymic epithelial tumors. A number of issues remain currently unresolved in thymic epithelial tumors surgery, namely the justification of the preoperative histological verification of the tumor process, the choice of the optimal surgical access to the anterior mediastinum, the need for and prognostic effect of lymph node dissection, and the determination of the required volume of the planned operation.
Full Text
##article.viewOnOriginalSite##About the authors
Evgeny A. Epifantsev
Federal Research and Clinical Center of Specialized Medical Care and Medical Technologies
Author for correspondence.
Email: epifantsev.e@gmail.com
ORCID iD: 0000-0001-9768-7440
SPIN-code: 1820-2153
Russian Federation, Moscow
Vladimir Yu. Gritsun
Federal Research and Clinical Center of Specialized Medical Care and Medical Technologies
Email: ords1313@gmail.com
ORCID iD: 0000-0001-7647-9853
Russian Federation, Moscow
Aishe A. Keshvedinova
Federal Research and Clinical Center of Specialized Medical Care and Medical Technologies
Email: aishe1998@mail.ru
ORCID iD: 0000-0002-0045-2715
SPIN-code: 1577-0901
Russian Federation, Moscow
Alexander V. Smirnov
Federal Research and Clinical Center of Specialized Medical Care and Medical Technologies
Email: alvsmirnov@mail.ru
ORCID iD: 0000-0003-3897-8306
SPIN-code: 5619-1151
MD, PhD
Russian Federation, MoscowYury V. Ivanov
Federal Research and Clinical Center of Specialized Medical Care and Medical Technologies; Central Research Institute of Tuberculosis
Email: ivanovkb83@yandex.ru
ORCID iD: 0000-0001-6209-4194
SPIN-code: 3240-4335
MD, PhD, Dr. Sci. (Med.), Professor
Russian Federation, Moscow; MoscowReferences
- Engels EA, Pfeiffer RM. Malignant thymoma in the United States: Demographic patterns in incidence and associations with subsequent malignancies. Int J Cancer. 2003;105(4): 546–551. doi: 10.1002/ijc.11099
- Minervini F, Kocher GJ. When to suspect a thymoma: Clinical point of view. J Thorac Dis. 2020;12(12):7613–7618. doi: 10.21037/jtd-2019-thym-05
- Engels EA. Epidemiology of thymoma and associated malignancies. J Thorac Oncol. 2010;5(10 Suppl 4):S260–S265. doi: 10.1097/JTO.0b013e3181f1f62d
- Lee Y, Samarasinghe Y, Patel J, et al. The short and long-term effects of open vs minimally invasive thymectomy in myasthenia gravis patients: A systematic review and meta-analysis. Surg Endosc. 2023;37(5):3321–3339. doi: 10.1007/s00464-022-09757-y
- Marx A, Ströbel P, Badve SS, et al. ITMIG consensus statement on the use of the WHO histological classification of thymoma and thymic carcinoma: Refined definitions, histological criteria, and reporting. J Thorac Oncol. 2014;9(5):596–611. doi: 10.1097/JTO.0000000000000154
- Den Bakker MA, Roden AC, Marx A, Marino M. Histologic classification of thymoma: A practical guide for routine cases. J Thorac Oncol. 2014;9(9 Suppl 2):S125–S130. doi: 10.1097/JTO.0000000000000297
- Padda SK, Yao X, Antonicelli A, et al. Paraneoplastic syndromes and thymic malignancies: An examination of the international thymic malignancy interest group retrospective database. J Thorac Oncol. 2018;13(3):436–446. doi: 10.1016/j.jtho.2017.11.118
- Conforti F, Pala L, Giaccone G, de Pas T. Thymic epithelial tumors: From biology to treatment. Cancer Treat Rev. 2020; 86:102014. doi: 10.1016/j.ctrv.2020.102014
- Detterbeck FC, Nicholson AG, Kondo K, et al. The Masaoka-Koga stage classification for thymic malignancies: Clarification and definition of terms. J Thorac Oncol. 2011;6(7 Suppl 3): S1710–S1716. doi: 10.1097/JTO.0b013e31821e8cff
- Fukui T, Fukumoto K, Okasaka T, et al. Clinical evaluation of a new tumour-node-metastasis staging system for thymic malignancies proposed by the International Association for the Study of Lung Cancer Staging and Prognostic Factors Committee and the International Thymic Malignancy Interest Group. Eur J Cardiothorac Surg. 2016;49(2):574–579. doi: 10.1093/ejcts/ezv389
- Strange CD, Ahuja J, Shroff GS, et al. Imaging evaluation of thymoma and thymic carcinoma. Front Oncol. 2022;11:810419. doi: 10.3389/fonc.2021.810419
- Li HR, Gao J, Jin C, Jiang JH, Ding JY. Comparison between CT and MRI in the diagnostic accuracy of thymic masses. J Cancer. 2019;10(14):3208–3213. doi: 10.7150/jca.30240
- Takahashi K, Al-Janabi NJ. Computed tomography and magnetic resonance imaging of mediastinal tumors. J Magn Reson Imaging. 2010;32(6):1325–1339. doi: 10.1002/jmri.22377
- Tuan PA, Duc NM. Magnetic resonance imaging characteristics of thymoma in Vietnamese patients with myasthenia gravis in relation to histopathological type and disease staging. Contemp Oncol (Pozn). 2020;24(3):193–199. doi: 10.5114/wo.2020.98861
- Heeger AP, Ackman JB. Added value of magnetic resonance imaging for the evaluation of mediastinal lesions. Radiol Clin North Am. 2021;59(2):251–277. doi: 10.1016/j.rcl.2020.11.001
- Mikail N, Khalil A, Rouzet F. Mediastinal masses: 18F-FDG-PET/CT features based on the international thymic malignancy interest group classification. Semin Nucl Med. 2021;51(1):79–97. doi: 10.1053/j.semnuclmed.2020.07.007
- Toker A, Erus S, Kaba E, et al. Has there been a paradigm shift in mediastinal surgery from open to minimally invasive, and from magnetic resonance imaging (MRI) to positron emission tomography-computerized tomography (PET-CT) in the last decade? Surg Endosc. 2014;28(3):861–865. doi: 10.1007/s00464-013-3233-8
- Willner J, Zhou F, Moreira AL. Diagnostic challenges in the cytology of thymic epithelial neoplasms. Cancers (Basel). 2022;14(8):2013. doi: 10.3390/cancers14082013
- Illei PB, Shyu S. Fine needle aspiration of thymic epithelial neoplasms and non-neoplastic lesions. Semin Diagn Pathol. 2020;37(4):166–173. doi: 10.1053/j.semdp.2020.04.006
- Padda SK, Keijzers M, Wakelee HA. Pretreatment biopsy for thymic epithelial tumors-does histology subtype matter for treatment strategy? J Thorac Dis. 2016;8(8):1895–1900. doi: 10.21037/jtd.2016.06.77
- Girard N, Ruffini E, Marx A, et al.; ESMO Guidelines Committee. Thymic epithelial tumours: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up. Ann Oncol. 2015;26(Suppl 5):v40–v55. doi: 10.1093/annonc/mdv277
- Ruffini E, Filosso PL, Guerrera F, et al. Optimal surgical approach to thymic malignancies: New trends challenging old dogmas. Lung Cancer. 2018;118:161–170. doi: 10.1016/j.lungcan.2018.01.025
- Solis-Pazmino P, Baiu I, Lincango-Naranjo E, et al. Impact of the surgical approach to thymectomy upon complete stable remission rates in myasthenia gravis: A meta-analysis. Neurology. 2021;97(4):e357–e368. doi: 10.1212/WNL.0000000000012153
- Li J, Liu Y, Zhang X, et al. Prognostic factors for overall survival after surgical resection in patients with thymic epithelial tumors: A systematic review and meta-analysis. Med (Baltimore). 2022;101(39):e30867. doi: 10.1097/MD.0000000000030867
- Yano M, Fujii Y, Yoshida J, et al. A phase II study of partial and subtotal thymectomy for thymoma (JART02). World J Surg. 2017;41(8):2033–2038. doi: 10.1007/s00268-017-3990-y
- Odaka M, Akiba T, Yabe M, et al. Unilateral thoracoscopic subtotal thymectomy for the treatment of stage I and II thymoma. Eur J Cardiothorac Surg. 2010;37(4):824–826. doi: 10.1016/j.ejcts.2009.10.003
- Xu C, Zhang Q, Li J, et al. Comparison of clinical outcomes and prognosis between thymectomy and thymomectomy in non-myasthenic patients with early-stage thymoma: A systematic review andmeta-analysis. Asian J Surg. 2023; S1015-9584(23)00371-8. doi: 10.1016/j.asjsur.2023.03.063
- Pulle MV, Asaf BB, Puri HV, et al. Meta-analysis of limited thymectomy versus total thymectomy for masaoka stage i and ii thymoma. J Chest Surg. 2021;54(2):127–136. doi: 10.5090/jcs.20.140
- Blalock A, Mason MF, Morgan HJ, Riven SS. Myasthenia gravis and tumors of the thymic region: Report of a case in which the tumor was removed. Ann Surg. 1939;110(4):544–561. doi: 10.1097/00000658-193910000-00005
- Landreneau RJ, Mack MJ, Hazelrigg SR, et al. Video-assisted thoracic surgery: Basic technical concepts and intercostal approach strategies. Ann Thorac Surg. 1992;54(4):800–807. doi: 10.1016/0003-4975(92)91040-g
- Scorsetti M, Leo F, Trama A, et al. Thymoma and thymic carcinomas. Crit Rev Oncol Hematol. 2016;99:332–350. doi: 10.1016/j.critrevonc.2016.01.012
- Qi K, Wang B, Wang B, et al. Video-assisted thoracoscopic surgery thymectomy versus open thymectomy in patients with myasthenia gravis: A meta-analysis. Acta Chir Belg. 2016;116(5):282–288. doi: 10.1080/00015458.2016.1176419
- Batirel HF. Minimally invasive techniques in thymic surgery: A worldwide perspective. J Vis Surg. 2018;4:7. doi: 10.21037/jovs.2017.12.18
- Okumura M, Shintani Y, Ohta M, et al. Minimally invasive surgical procedures for thymic disease in Asia. J Vis Surg. 2017;3:96. doi: 10.21037/jovs.2017.06.03
- Allakhverdiev A, Davydov M, Allakhverdieva G, Akhmedov P. Thoracoscopic thymectomy: The method of choise in surgical treatment of non-invasive thymomas. Ann Med Surg (Lond). 2018;42:29–34. doi: 10.1016/j.amsu.2018.12.005
- Matilla JR, Klepetko W, Moser B. Thymic minimally invasive surgery: State of the art across the world-Europe. J Vis Surg. 2017;3:70. doi: 10.21037/jovs.2017.04.01
- Yang Y, Dong J, Huang Y. Thoracoscopic thymectomy versus open thymectomy for the treatment of thymoma: A meta-analysis. Eur J Surg Oncol. 2016;42(11):1720–1728. doi: 10.1016/j.ejso.2016.03.029
- Zieliński M, Kuzdzał J, Szlubowski A, Soja J. Transcervical-subxiphoid-videothoracoscopic “maximal” thymectomy: Operative technique and early results. Ann Thorac Surg. 2004;78(2): 404–410. doi: 10.1016/j.athoracsur.2004.02.021
- Refai M, Gonzalez-Rivas D, Guiducci GM, et al. Uniportal video-assisted thoracoscopic thymectomy: The glove-port with carbon dioxide insufflation. Gland Surg. 2020;9(4):879–885. doi: 10.21037/gs-19-521
- Ooi A, Qiang F. Uniportal video assisted thoracoscopic surgery thymectomy (left approach). J Vis Surg. 2016;2:12. doi: 10.3978/j.issn.2221-2965.2015.12.18
- Wu CF, Gonzalez-Rivas D, Wen CT, et al. Single-port video-assisted thoracoscopic mediastinal tumour resection. Interact Cardiovasc Thorac Surg. 2015;21(5):644–649. doi: 10.1093/icvts/ivv224
- Bedetti B, Solli P, Lawrence D, et al. Single port video-assisted thoracoscopic thymectomy. J Vis Surg. 2016;2:149. doi: 10.21037/jovs.2016.08.07
- Dunning J. Video-assisted thoracoscopic microthymectomy. Ann Cardiothorac Surg. 2015;4(6):550–555. doi: 10.3978/j.issn.2225-319X.2015.11.04
- Li M, Xu L, Li L, et al. The early perioperative outcomes of subxiphoid approach versus lateral intercostal approach thoracoscopic thymectomy for thymic tumors: A meta-analysis. J Laparoendosc Adv Surg Tech A. 2022;32(3):256–264. doi: 10.1089/lap.2021.0036
- Mao Y, Lan Y, Cui F, et al. Comparison of different surgical approaches for anterior mediastinal tumor. J Thorac Dis. 2020;12(10):5430–5439. doi: 10.21037/jtd-20-266
- Chiu CH, Chao YK, Liu YH. Subxiphoid approach for video-assisted thoracoscopic surgery: An update. J Thorac Dis. 2018; 10(Suppl 14):S1662–S1665. doi: 10.21037/jtd.2018.04.01
- Zieliński M, Rybak M, Wilkojc M, et al. Subxiphoid video-assisted thorascopic thymectomy for thymoma. Ann Cardiothorac Surg. 2015;4(6):564–566. doi: 10.3978/j.issn.2225-319X.2015.10.04
- Mao T, Zhang X, Yang Y, et al. A uniport subxiphoid approach with a modified sternum retractor is safe and feasible for anterior mediastinal tumors. J Thorac Dis. 2023;15(3):1364–1372. doi: 10.21037/jtd-23-244
- Kido T, Hazama K, Inoue Y, et al. Resection of anterior mediastinal masses through an infrasternal approach. Ann Thorac Surg. 1999;67(1):263–265. doi: 10.1016/s0003-4975(98)01210-7
- Пикин О.В., Рябов А.Б., Мартынова Д.Е., Салимов З.М. Малоинвазивные технологии в хирургии вилочковой железы (обзор литературы) // Вестник хирургии имени И.И. Грекова. 2021. Т. 180, № 4. С. 99–105. [Pikin OV, Ryabov AB, Martinova DY, Salimov ZM. Minimally invasive techniques in thymic surgery (review of literature). Grekov’s Bulletin of Surgery. 2021;180(4):99–105. (In Russ)]. doi: 10.24884/0042-4625-2021-180-4-99-105
- Пикин О.В., Рябов А.Б., Щербакова Н.И., и др. Ретимэктомия субксифоидальным доступом у больной с тимомой, ассоциированной с генерализованной формой миастении // Онкология. Журнал им. П.А. Герцена. 2022;11(1): 50–54. [Pikin OV, Ryabov AB, Shcherbakova NI, et al. Subxiphoid rethymectomy in a female patient with thymoma associated with generalized myasthenia gravis. P.A. Herzen Journal of Oncology. 2022;11(1):50–54. (In Russ). https://doi.org/10.17116/onkolog20221101150] doi: 10.17116/onkolog20221101150
- Дзидзава И.И., Дмитроченко И.В., Фуфаев Е.Е., и др. Cлучай тимомэктомии из комбинированного доступа // Вестник хирургии имени И.И. Грекова. 2019. Т. 178, № 5. С. 103–106. [Dzidzava II, Dmitrochenko IV, Fufaev EE, et al. The clinical case of thymectomy using combined approaches. Grekov’s Bulletin of Surgery. 2019;178(5):103–106. (In Russ).] doi: 10.24884/0042-4625-2019-178-5-103-106
- Wang H, Wang M, Xin N, et al. Effect evaluation of subxiphoid and intercostal thymectomy: A meta-analysis and systematic review. Front Surg. 2022;9:925003. doi: 10.3389/fsurg.2022.925003
- Li J, Qi G, Liu Y, et al. Meta-analysis of subxiphoid approach versus lateral approach for thoracoscopic Thymectomy. J Cardiothorac Surg. 2020;15(1):89. doi: 10.1186/s13019-020-01135-w
- Kondo K, Monden Y. Lymphogenous and hematogenous metastasis of thymic epithelial tumors. Ann Thorac Surg. 2003;76(6):1859–1865. doi: 10.1016/s0003-4975(03)01017-8
- Brascia D, de Palma A, Schiavone M, et al. Lymph nodes involvement and lymphadenectomy in thymic tumors: Tentative answers for unsolved questions. Cancers (Basel). 2021;13(20): 5085. doi: 10.3390/cancers13205085