Skip to main content

Advertisement

Log in

Surgical management of thymic epithelial tumors

  • Review Article
  • Published:
Surgery Today Aims and scope Submit manuscript

Abstract

Resection is the mainstay of treatment for thymic epithelial tumors (TETs), with complete removal of the tumor and involved organs being the ultimate aim. The choice of surgical approach plays a major role in defining treatment success, and the optimal choice of method should thus provide an adequate surgical view to achieve complete tumor resection. While median sternotomy is considered the gold standard for access to the mediastinum, several minimally invasive approaches to thymectomy have been described, including video-assisted robotic-assisted thymectomy, although the oncological outcomes of that procedure remain unclear. A multimodal approach incorporating chemotherapy or chemoradiotherapy followed by extended surgery may improve resectability and outcomes for patients with advanced TETs. Surgical debulking is also reportedly acceptable for invasive thymoma because of its potential for achieving favorable outcomes. Re-resection is an acceptable option for patients with recurrent thymoma after initial resection, and repeat resection for recurrent pleural dissemination seems effective. Here, the literature on current clinical practices in the surgical management and treatment of TETs is reviewed.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. Kondo K. Therapy for thymic epithelial tumors. Gen Thorac Cardiovasc Surg. 2014;62(8):468–74 (Epub 2014/06/11).

    PubMed  Google Scholar 

  2. Weis CA, Yao X, Deng Y, Detterbeck FC, Marino M, Nicholson AG, et al. The impact of thymoma histotype on prognosis in a worldwide database. J Thorac Oncol. 2015;10(2):367–72 (Epub 2015/01/24).

    PubMed  PubMed Central  Google Scholar 

  3. Marx A, Chan JK, Coindre JM, Detterbeck F, Girard N, Harris NL, et al. The 2015 World Health Organization classification of tumors of the thymus: continuity and changes. J Thorac Oncol. 2015;10(10):1383–95 (Epub 2015/08/22).

    CAS  PubMed  PubMed Central  Google Scholar 

  4. Galateau-Salle F, Churg A, Roggli V, Travis WD. The 2015 World Health Organization classification of tumors of the pleura: advances since the 2004 classification. J Thorac Oncol. 2016;11(2):142–54 (Epub 2016/01/27).

    PubMed  Google Scholar 

  5. Masaoka A, Monden Y, Nakahara K, Tanioka T. Follow-up study of thymomas with special reference to their clinical stages. Cancer. 1981;48(11):2485–92 (Epub 1981/12/01).

    CAS  PubMed  Google Scholar 

  6. Detterbeck FC, Asamura H, Crowley J, Falkson C, Giaccone G, Giroux D, et al. The IASLC/ITMIG thymic malignancies staging project: development of a stage classification for thymic malignancies. J Thorac Oncol. 2013;8(12):1467–73 (Epub 2014/01/07).

    PubMed  Google Scholar 

  7. Bernard C, Frih H, Pasquet F, Kerever S, Jamilloux Y, Tronc F, et al. Thymoma associated with autoimmune diseases: 85 cases and literature review. Autoimmun Rev. 2016;15(1):82–92 (Epub 2015/09/27).

    CAS  PubMed  Google Scholar 

  8. Ruffini E, Venuta F. Management of thymic tumors: a European perspective. J Thorac Dis. 2014;6(Suppl 2):S228–S23737 (Epub 2014/05/29).

    PubMed  PubMed Central  Google Scholar 

  9. Chen J, Yang Y, Zhu D, Chen G, Wei S, Qiu X, et al. Thymoma with pure red cell aplasia and Good's syndrome. Ann Thorac Surg. 2011;91(5):1620–2 (Epub 2011/04/29).

    PubMed  Google Scholar 

  10. Christakis I, Qiu W, Silva Figueroa AM, Hyde S, Cote GJ, Busaidy NL, et al. Clinical features, treatments, and outcomes of patients with thymic carcinoids and multiple endocrine neoplasia type 1 syndrome at MD Anderson Cancer Center. Hormones Cancer. 2016;7(4):279–87 (Epub 2016/06/18).

    CAS  PubMed  Google Scholar 

  11. Kondo K, Monden Y. Therapy for thymic epithelial tumors: a clinical study of 1,320 patients from Japan. Ann Thorac Surg. 2003;76(3):878–84 (discussion 84–5, Epub 2003/09/10).

    PubMed  Google Scholar 

  12. Kondo K. Optimal therapy for thymoma. J Med Investig. 2008;55(1–2):17–28 (Epub 2008/03/06).

    Google Scholar 

  13. Marom EM, Rosado-de-Christenson ML, Bruzzi JF, Hara M, Sonett JR, Ketai L. Standard report terms for chest computed tomography reports of anterior mediastinal masses suspicious for thymoma. J Thorac Oncol. 2011;6(7 Suppl 3):S1717–S17231723 (Epub 2011/09/29).

    PubMed  Google Scholar 

  14. Lee JH, Park CM, Park SJ, Bae JS, Lee SM, Goo JM. Value of computerized 3D shape analysis in differentiating encapsulated from invasive thymomas. PLoS ONE. 2015;10(5):e0126175 (Epub 2015/05/06).

    PubMed  PubMed Central  Google Scholar 

  15. Broncano J, Alvarado-Benavides AM, Bhalla S, Alvarez-Kindelan A, Raptis CA, Luna A. Role of advanced magnetic resonance imaging in the assessment of malignancies of the mediastinum. World J Radiol. 2019;11(3):27–45 (Epub 2019/04/06).

    PubMed  PubMed Central  Google Scholar 

  16. Fukumoto K, Taniguchi T, Ishikawa Y, Kawaguchi K, Fukui T, Kato K, et al. The utility of [18F]-fluorodeoxyglucose positron emission tomography-computed tomography in thymic epithelial tumours. Eur J Cardiothorac Surg. 2012;42(6):e152–e156156 (Epub 2012/10/02).

    PubMed  Google Scholar 

  17. Kaira K, Sunaga N, Ishizuka T, Shimizu K, Yamamoto N. The role of [(1)(8)F]fluorodeoxyglucose positron emission tomography in thymic epithelial tumors. Cancer Imaging. 2011;11:195–201 (Epub 2011/12/06).

    PubMed  PubMed Central  Google Scholar 

  18. Drevet G, Collaud S, Tronc F, Girard N, Maury JM. Optimal management of thymic malignancies: current perspectives. Cancer Manag Res. 2019;11:6803–14 (Epub 2019/08/16).

    PubMed  PubMed Central  Google Scholar 

  19. Shintani Y, Funaki S, Ose N, Kanou T, Fukui E, Minami M. Surgical approach for thymic epithelial tumor. J Thorac Dis. 2019;11(8):E127–E130130 (Epub 2019/09/29).

    PubMed  PubMed Central  Google Scholar 

  20. Limmer S, Merz H, Kujath P. Giant thymoma in the anterior-inferior mediastinum. Interact Cardiovasc Thorac Surg. 2010;10(3):451–3 (Epub 2009/12/31).

    PubMed  Google Scholar 

  21. Fujiwara A, Funaki S, Ose N, Kanou T, Kanzaki R, Minami M, et al. Surgical resection for advanced thymic malignancy with pulmonary hilar invasion using hemi-clamshell approach. J Thorac Dis. 2018;10(12):6475–81 (Epub 2019/02/13).

    PubMed  PubMed Central  Google Scholar 

  22. Masaoka A, Ito Y, Yasumitsu T. Anterior approach for tumor of the superior sulcus. J Thorac Cardiovasc Surg. 1979;78(3):413–5 (Epub 1979/09/01).

    CAS  PubMed  Google Scholar 

  23. Haruki T, Wakahara M, Taniguchi Y, Nakamura Y, Nishimura M, Nakamura H. Successful multimodality treatment for locally advanced primary thymic adenocarcinoma: report of a case. J Surg Case Rep. 2016;8:1–4 (Epub 2016/09/09).

    Google Scholar 

  24. Ohta M, Hirabayasi H, Okumura M, Minami M, Matsuda H. Thoracoscopic thymectomy using anterior chest wall lifting method. Ann Thorac Surg. 2003;76(4):1310–1 (Epub 2003/10/08).

    PubMed  Google Scholar 

  25. Nakagiri T, Inoue M, Shintani Y, Funaki S, Kawamura T, Minami M, et al. Improved procedures and comparative results for video-assisted thoracoscopic extended thymectomy for myasthenia gravis. Surg Endosc. 2015;29(9):2859–65 (Epub 2014/12/10).

    PubMed  Google Scholar 

  26. Kido T, Hazama K, Inoue Y, Tanaka Y, Takao T. Resection of anterior mediastinal masses through an infrasternal approach. Ann Thorac Surg. 1999;67(1):263–5 (Epub 1999/03/23).

    CAS  PubMed  Google Scholar 

  27. Suda T, Hachimaru A, Tochii D, Maeda R, Tochii S, Takagi Y. Video-assisted thoracoscopic thymectomy versus subxiphoid single-port thymectomy: initial resultsdagger. Eur J Cardiothorac Surg. 2016;49(Suppl 1):i54–i5858 (Epub 2015/10/16).

    PubMed  Google Scholar 

  28. Rueckert J, Swierzy M, Badakhshi H, Meisel A, Ismail M. Robotic-assisted thymectomy: surgical procedure and results. Thorac Cardiovasc Surg. 2015;63(3):194–200 (Epub 2015/03/26).

    PubMed  Google Scholar 

  29. Suda T, Kaneda S, Hachimaru A, Tochii D, Maeda R, Tochii S, et al. Thymectomy via a subxiphoid approach: single-port and robot-assisted. J Thorac Dis. 2016;8(Suppl 3):S265–S271271 (Epub 2016/03/26).

    PubMed  PubMed Central  Google Scholar 

  30. Petersen RH. Video-assisted thoracoscopic thymectomy using 5-mm ports and carbon dioxide insufflation. Ann Cardiothorac Surg. 2016;5(1):51–5 (Epub 2016/02/24).

    PubMed  PubMed Central  Google Scholar 

  31. Ruckert JC, Swierzy M, Ismail M. Comparison of robotic and nonrobotic thoracoscopic thymectomy: a cohort study. J Thorac Cardiovasc Surg. 2011;141(3):673–7 (Epub 2011/02/22).

    PubMed  Google Scholar 

  32. Keijzers M, de Baets M, Hochstenbag M, Abdul-Hamid M, Zur Hausen A, van der Linden M, et al. Robotic thymectomy in patients with myasthenia gravis: neurological and surgical outcomes. Eur J Cardiothorac Surg. 2015;48(1):40–5 (Epub 2014/09/23).

    PubMed  Google Scholar 

  33. Agatsuma H, Yoshida K, Yoshino I, Okumura M, Higashiyama M, Suzuki K, et al. Video-assisted thoracic surgery thymectomy versus sternotomy thymectomy in patients with thymoma. Ann Thorac Surg. 2017;104(3):1047–53 (Epub 2017/06/18).

    PubMed  Google Scholar 

  34. Kimura T, Inoue M, Kadota Y, Shiono H, Shintani Y, Nakagiri T, et al. The oncological feasibility and limitations of video-assisted thoracoscopic thymectomy for early-stage thymomas. Eur J Cardiothorac Surg. 2013;44(3):e214–e218218 (Epub 2013/06/14).

    PubMed  Google Scholar 

  35. Okumura M, Yoshino I, Yano M, Watanabe SI, Tsuboi M, Yoshida K, et al. Tumour size determines both recurrence-free survival and disease-specific survival after surgical treatment for thymoma. Eur J Cardiothorac Surg. 2019;56(1):174–81 (Epub 2019/02/21).

    PubMed  Google Scholar 

  36. Zhang X, Gu Z, Fang W. Minimally invasive surgery in thymic malignances: the new standard of care. J Thorac Dis. 2018;10(Suppl 14):S1666–S16701670 (Epub 2018/07/24).

    PubMed  PubMed Central  Google Scholar 

  37. Nakagawa K, Yokoi K, Nakajima J, Tanaka F, Maniwa Y, Suzuki M, et al. Is Thymomectomy alone appropriate for stage I (T1N0M0) thymoma? Results of a propensity-score analysis. Ann Thorac Surg. 2016;101(2):520–6 (Epub 2015/10/21).

    PubMed  Google Scholar 

  38. Onuki T, Ishikawa S, Iguchi K, Goto Y, Sakai M, Inagaki M, et al. Limited thymectomy for stage I or II thymomas. Lung Cancer. 2010;68(3):460–5 (Epub 2009/09/01).

    PubMed  Google Scholar 

  39. Shintani Y, Inoue M, Kawamura T, Funaki S, Minami M, Okumura M. Multimodality treatment for advanced thymic carcinoma: outcomes of induction therapy followed by surgical resection in 16 cases at a single institution. Gen Thorac Cardiovasc Surg. 2015;63(3):159–63 (Epub 2014/10/15).

    PubMed  Google Scholar 

  40. Momozane T, Inoue M, Shintani Y, Funaki S, Kawamura T, Minami M, et al. Trimodality therapy for an advanced thymic carcinoma with both aorta and vena cava invasion. Ann Thorac Surg. 2016;102(2):e139–e141141 (Epub 2016/07/28).

    PubMed  Google Scholar 

  41. Rea F, Marulli G, Di Chiara F, Schiavon M, Perissinotto E, Breda C, et al. Multidisciplinary approach for advanced stage thymic tumors: long-term outcome. Lung Cancer. 2011;72(1):68–72 (Epub 2010/08/17).

    PubMed  Google Scholar 

  42. Wright CD, Choi NC, Wain JC, Mathisen DJ, Lynch TJ, Fidias P. Induction chemoradiotherapy followed by resection for locally advanced Masaoka stage III and IVA thymic tumors. Ann Thorac Surg. 2008;85(2):385–9 (Epub 2008/01/29).

    PubMed  Google Scholar 

  43. Furugen M, Sekine I, Tsuta K, Horinouchi H, Nokihara H, Yamamoto N, et al. Combination chemotherapy with carboplatin and paclitaxel for advanced thymic cancer. Jpn J Clin Oncol. 2011;41(8):1013–6 (Epub 2011/07/12).

    PubMed  Google Scholar 

  44. Fukuda M, Funaki S, Yamazaki T, Sato S, Mukae H, Takenoyama M, et al. S-1 plus cisplatin with concurrent radiotherapy for locally advanced thymic carcinoma: study protocol of LOGIK1605/JART-1501. Thorac Cancer. 2020;11(3):693–6 (Epub 2020/02/06).

    CAS  PubMed  PubMed Central  Google Scholar 

  45. Ose N, Inoue M, Morii E, Shintani Y, Sawabata N, Okumura M. Multimodality therapy for large cell neuroendocrine carcinoma of the thymus. Ann Thorac Surg. 2013;96(4):e85–e8787 (Epub 2013/10/04).

    PubMed  Google Scholar 

  46. Riely GJ, Huang J. Induction therapy for locally advanced thymoma. J Thorac Oncol. 2010;5(10 Suppl 4):S323–S326326 (Epub 2010/10/05).

    PubMed  Google Scholar 

  47. Okumura M, Miyoshi S, Takeuchi Y, Yoon HE, Minami M, Takeda SI, et al. Results of surgical treatment of thymomas with special reference to the involved organs. J Thorac Cardiovasc Surg. 1999;117(3):605–13 (Epub 1999/02/27).

    CAS  PubMed  Google Scholar 

  48. Kanzaki R, Kanou T, Ose N, Funaki S, Shintani Y, Minami M, et al. Long-term outcomes of advanced thymoma in patients undergoing preoperative chemotherapy or chemoradiotherapy followed by surgery: a 20-year experience. Interact Cardiovasc Thorac Surg. 2019;28(3):360–7 (Epub 2018/09/27).

    PubMed  Google Scholar 

  49. Korst RJ, Bezjak A, Blackmon S, Choi N, Fidias P, Liu G, et al. Neoadjuvant chemoradiotherapy for locally advanced thymic tumors: a phase II, multi-institutional clinical trial. J Thorac Cardiovasc Surg. 2014;147(1):36–44 (6 e1, Epub 2013/10/22).

    PubMed  Google Scholar 

  50. Schmitt J, Loehrer PJ Sr. The role of chemotherapy in advanced thymoma. J Thorac Oncol. 2010;5(10 Suppl 4):S357–S360360 (Epub 2010/10/05).

    PubMed  Google Scholar 

  51. Yokoi K, Matsuguma H, Nakahara R, Kondo T, Kamiyama Y, Mori K, et al. Multidisciplinary treatment for advanced invasive thymoma with cisplatin, doxorubicin, and methylprednisolone. J Thorac Oncol. 2007;2(1):73–8 (Epub 2007/04/06).

    PubMed  Google Scholar 

  52. Kobayashi Y, Fujii Y, Yano M, Sasaki H, Yukiue H, Haneda H, et al. Preoperative steroid pulse therapy for invasive thymoma: clinical experience and mechanism of action. Cancer. 2006;106(9):1901–7 (Epub 2006/04/07).

    CAS  PubMed  Google Scholar 

  53. Fujiwara A, Inoue M, Kusumoto H, Shintani Y, Maeda T, Okumura M. Myasthenic crisis caused by preoperative chemotherapy with steroid for advanced thymoma. Ann Thorac Surg. 2015;99(1):e11–e13 (Epub 2015/01/06).

    PubMed  Google Scholar 

  54. Venuta F, Rendina EA, Longo F, De Giacomo T, Anile M, Mercadante E, et al. Long-term outcome after multimodality treatment for stage III thymic tumors. Ann Thorac Surg. 2003;76(6):1866–72 (discussion 72, Epub 2003/12/12).

    PubMed  Google Scholar 

  55. Shintani Y, Kanzaki R, Kusumoto H, Nakagiri T, Inoue M, Okumura M. Pleuropneumonectomy for a large thymoma with multiple pleural dissemination using median sternotomy followed by posterolateral thoracotomy. Surg Case Rep. 2015;1(1):75 (Epub 2015/09/15).

    PubMed  PubMed Central  Google Scholar 

  56. Wright CD. Pleuropneumonectomy for the treatment of Masaoka stage IVA thymoma. Ann Thorac Surg. 2006;82(4):1234–9 (Epub 2006/09/26).

    PubMed  Google Scholar 

  57. Okuda K, Yano M, Yoshino I, Okumura M, Higashiyama M, Suzuki K, et al. Thymoma patients with pleural dissemination: nationwide retrospective study of 136 cases in Japan. Ann Thorac Surg. 2014;97(5):1743–8 (Epub 2014/03/25).

    PubMed  Google Scholar 

  58. Ried M, Neu R, Schalke B, von Susskind-Schwendi M, Sziklavari Z, Hofmann HS. Radical surgical resection of advanced thymoma and thymic carcinoma infiltrating the heart or great vessels with cardiopulmonary bypass support. J Cardiothorac Surg. 2015;10:137 (Epub 2015/10/31).

    PubMed  PubMed Central  Google Scholar 

  59. Wright CD. Extended resections for thymic malignancies. J Thorac Oncol. 2010;5(10 Suppl 4):S344–S347347 (Epub 2010/10/05).

    PubMed  Google Scholar 

  60. Shimizu N, Date H, Moriyama S, Ando A, Teramoto S. Reconstruction of the superior vena cava in patients with mediastinal malignancies. Eur J Cardiothorac Surg. 1991;5(11):575–8 (Epub 1991/01/01).

    CAS  PubMed  Google Scholar 

  61. Zhang Z, Huang M, Pan X. Prosthetic reconstruction of superior vena cava system for thymic tumor: a retrospective analysis of 22 cases. Thorac Cardiovasc Surg. 2020;. https://doi.org/10.1055/s-0039-3401044(Epub 2020/02/01).

    Article  PubMed  Google Scholar 

  62. Sekine Y, Suzuki H, Saitoh Y, Wada H, Yoshida S. Prosthetic reconstruction of the superior vena cava for malignant disease: surgical techniques and outcomes. Ann Thorac Surg. 2010;90(1):223–8 (Epub 2010/07/09).

    PubMed  Google Scholar 

  63. Shintani Y, Ohta M, Minami M, Shiono H, Hirabayashi H, Inoue M, et al. Long-term graft patency after replacement of the brachiocephalic veins combined with resection of mediastinal tumors. J Thorac Cardiovasc Surg. 2005;129(4):809–12 (Epub 2005/04/12).

    PubMed  Google Scholar 

  64. Venuta F, Rendina EA, Klepetko W, Rocco G. Surgical management of stage III thymic tumors. Thorac Surg Clin. 2011;21(1):85–91 (vii, Epub 2010/11/13).

    PubMed  Google Scholar 

  65. Attaran S, Acharya M, Anderson JR, Punjabi PP. Does surgical debulking for advanced stages of thymoma improve survival? Interact Cardiovasc Thorac Surg. 2012;15(3):494–7 (Epub 2012/06/16).

    PubMed  PubMed Central  Google Scholar 

  66. Kuno H, Funaki S, Kimura K, Shimamura K, Kin K, Kuratani T, et al. Complete resection of local advanced thymic carcinoma with total aortic arch replacement after chemotherapy: a case report. Surg Case Rep. 2019;5(1):198 (Epub 2019/12/14).

    PubMed  PubMed Central  Google Scholar 

  67. Shintani Y, Shimamura K, Funaki S, Kimura K, Kin K, Kuratani T, et al. Combined aortic arch resection for lung cancer using total rerouting of supra-arch vessels. Ann Thorac Surg. 2019;107(6):e399–e401 (Epub 2018/12/05).

    PubMed  Google Scholar 

  68. Yamada Y, Yoshino I, Nakajima J, Miyoshi S, Ohnuki T, Suzuki M, et al. Surgical outcomes of patients with stage III thymoma in the Japanese Nationwide Database. Ann Thorac Surg. 2015;100(3):961–7 (Epub 2015/07/15).

    PubMed  Google Scholar 

  69. Yano M, Sasaki H, Moriyama S, Kawano O, Hikosaka Y, Masaoka A, et al. Preservation of phrenic nerve involved by stage III thymoma. Ann Thorac Surg. 2010;89(5):1612–9 (Epub 2010/04/27).

    PubMed  Google Scholar 

  70. Tokunaga T, Sawabata N, Kadota Y, Utsumi T, Minami M, Inoue M, et al. Efficacy of intra-operative unilateral diaphragm plication for patients undergoing unilateral phrenicotomy during extended surgery. Eur J Cardiothorac Surg. 2010;38(5):600–3 (Epub 2010/05/19).

    PubMed  Google Scholar 

  71. Kimura K, Kanzaki R, Kimura T, Kanou T, Ose N, Funaki S, et al. Long-term outcomes after surgical resection for pleural dissemination of thymoma. Ann Surg Oncol. 2019;26(7):2073–80 (Epub 2019/03/30).

    PubMed  Google Scholar 

  72. Hamaji M, Kojima F, Omasa M, Sozu T, Sato T, Chen F, et al. A meta-analysis of debulking surgery versus surgical biopsy for unresectable thymoma. Eur J Cardiothorac Surg. 2015;47(4):602–7 (Epub 2014/07/13).

    PubMed  Google Scholar 

  73. Girard N, Ruffini E, Marx A, Faivre-Finn C, Peters S. Thymic epithelial tumours: ESMO clinical practice guidelines for diagnosis, treatment and follow-up. Ann Oncol. 2015;26(Suppl 5):v40–55 (Epub 2015/09/01).

    PubMed  Google Scholar 

  74. Utsumi T, Shiono H, Kadota Y, Matsumura A, Maeda H, Ohta M, et al. Postoperative radiation therapy after complete resection of thymoma has little impact on survival. Cancer. 2009;115(23):5413–20 (Epub 2009/08/18).

    PubMed  Google Scholar 

  75. Jackson MW, Palma DA, Camidge DR, Jones BL, Robin TP, Sher DJ, et al. The impact of postoperative radiotherapy for thymoma and thymic carcinoma. J Thorac Oncol. 2017;12(4):734–44 (Epub 2017/01/28).

    PubMed  Google Scholar 

  76. Ahmad U, Yao X, Detterbeck F, Huang J, Antonicelli A, Filosso PL, et al. Thymic carcinoma outcomes and prognosis: results of an international analysis. J Thorac Cardiovasc Surg. 2015;149(1):95–100 (1 e1–2, Epub 2014/12/20).

    PubMed  Google Scholar 

  77. Luo T, Zhao H, Zhou X. The clinical features, diagnosis and management of recurrent thymoma. J Cardiothorac Surg. 2016;11(1):140 (Epub 2016/09/02).

    PubMed  PubMed Central  Google Scholar 

  78. Mizuno T, Okumura M, Asamura H, Yoshida K, Niwa H, Kondo K, et al. Surgical management of recurrent thymic epithelial tumors: a retrospective analysis based on the Japanese nationwide database. J Thorac Oncol. 2015;10(1):199–205 (Epub 2014/09/24).

    PubMed  Google Scholar 

  79. Blumberg D, Port JL, Weksler B, Delgado R, Rosai J, Bains MS, et al. Thymoma: a multivariate analysis of factors predicting survival. Ann Thorac Surg. 1995;60(4):908–13 (discussion 14, Epub 1995/10/01).

    CAS  PubMed  Google Scholar 

  80. Okumura M, Shiono H, Inoue M, Tanaka H, Yoon HE, Nakagawa K, et al. Outcome of surgical treatment for recurrent thymic epithelial tumors with reference to world health organization histologic classification system. J Surg Oncol. 2007;95(1):40–4 (Epub 2006/12/29).

    PubMed  Google Scholar 

  81. Basse C, Thureau S, Bota S, Dansin E, Thomas PA, Pichon E, et al. Multidisciplinary tumor board decision making for postoperative radiotherapy in thymic epithelial tumors: insights from the RYTHMIC prospective cohort. J Thorac Oncol. 2017;12(11):1715–22 (Epub 2017/08/05).

    PubMed  Google Scholar 

  82. Girard N, Mornex F, Van Houtte P, Cordier JF, van Schil P. Thymoma: a focus on current therapeutic management. J Thorac Oncol. 2009;4(1):119–26 (Epub 2008/12/20).

    PubMed  Google Scholar 

  83. Lemma GL, Lee JW, Aisner SC, Langer CJ, Tester WJ, Johnson DH, et al. Phase II study of carboplatin and paclitaxel in advanced thymoma and thymic carcinoma. J Clin Oncol. 2011;29(15):2060–5 (Epub 2011/04/20).

    CAS  PubMed  PubMed Central  Google Scholar 

  84. Zucali PA, De Pas T, Palmieri G, Favaretto A, Chella A, Tiseo M, et al. Phase II study of everolimus in patients with thymoma and thymic carcinoma previously treated with cisplatin-based chemotherapy. J Clin Oncol. 2018;36(4):342–9 (Epub 2017/12/15).

    CAS  PubMed  Google Scholar 

  85. Giaccone G, Kim C, Thompson J, McGuire C, Kallakury B, Chahine JJ, et al. Pembrolizumab in patients with thymic carcinoma: a single-arm, single-centre, phase 2 study. Lancet Oncol. 2018;19(3):347–55 (Epub 2018/02/06).

    CAS  PubMed  Google Scholar 

  86. Yamamoto Y, Iwahori K, Funaki S, Matsumoto M, Hirata M, Yoshida T, et al. Immunotherapeutic potential of CD4 and CD8 single-positive T cells in thymic epithelial tumors. Sci Rep. 2020;10(1):4064 (Epub 2020/03/07).

    CAS  PubMed  PubMed Central  Google Scholar 

  87. Safa H, Johnson DH, Trinh VA, Rodgers TE, Lin H, Suarez-Almazor ME, et al. Immune checkpoint inhibitor related myasthenia gravis: single center experience and systematic review of the literature. J Immunother Cancer. 2019;7(1):319.

    PubMed  PubMed Central  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Yasushi Shintani.

Ethics declarations

Conflict of interest

Yasushi Shintani and his co-authors have no conflicts of interest to declare.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Shintani, Y., Funaki, S., Ose, N. et al. Surgical management of thymic epithelial tumors. Surg Today 51, 331–339 (2021). https://doi.org/10.1007/s00595-020-02070-y

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00595-020-02070-y

Keywords

Navigation