Abstract
Background
Cases of thymoma with pleural dissemination are occasionally encountered, and their management is difficult. Some reports have noted that surgical treatment for dissemination is effective, although the long-term results and clinical course details remain unclear. The current study investigated the short- and long-term outcomes of surgical resection of pleural dissemination.
Methods
A retrospective review examined the medical records for 38 patients who underwent surgical resection for pleural dissemination occurring synchronously with a primary thymoma or metachronously after complete surgical resection of a primary thymoma between 1996 and 2017 at the authors’ institution. Clinical characteristics and prognostic factors were analyzed.
Results
The patients were classified into synchronous (n = 21) and metachronous (n = 17) groups. The 10-year overall survival rate was 59% for the synchronous group and 88% for the metachronous group. The median follow-up period for all the patients was 61 months (range 4–225 months). No perioperative deaths occurred. For all the patients, the 5- and 10-year overall survival rates were respectively 91% and 82%, and the 5- and 10-year relapse-free survival rates were respectively 29% and 19%. A significantly worse prognosis was observed for patients 50 years of age or older than for those younger than 50 years (p = 0.02). For 13 patients who underwent repeat resection for pleural dissemination, the prognosis was better than for those without repeat resection (p < 0.01).
Conclusion
Surgical resection of thymoma with pleural disseminated nodules can be safely performed and provides a favorable long-term outcome. Repeat resection is considered to be effective for achieving a good prognosis.
Similar content being viewed by others
References
Haniuda M, Kondo R, Numanami H, Makiuchi A, Machida A, Amano J. Recurrence of thymoma: clinicopathological features, reoperation, and outcome. J Surg Oncol. 2001;78:183–8.
Shinohara S, Hanagiri T, So T, et al. Results of surgical resection for patients with thymoma according to World Health Organization histology and Masaoka staging. Asian J Surg. 2012;35:144–8.
Kondo K, Monden Y. Therapy for thymic epithelial tumors: a clinical study of 1320 patients from Japan. Ann Thorac Surg. 2003;76:878–84.
Regnard J-F, Zinzindohoue F, Magdeleinat P, Guibert L, Spaggiari L, Levasseur P. Results of re-resection for recurrent thymomas. Ann Thorac Surg. 1997;64:1593–8.
Okumura M, Shiono H, Inoue M, et al. Outcome of surgical treatment for recurrent thymic epithelial tumors with reference to World Health Organization histologic classification system. J Surg Oncol. 2007;95:40–4.
Lucchi M, Davini F, Ricciardi R, et al. Management of pleural recurrence after curative resection of thymoma. J Thorac Cardiovasc Surg. 2009;137:1185–9.
Murakawa T, Karasaki T, Kitano K, et al. Invasive thymoma disseminated into the pleural cavity: mid-term results of surgical resection. Eur J Cardiothorac Surg. 2015;47:567–72.
Yano M, Sasaki H, Yukiue H, et al. Thymoma with dissemination: efficacy of macroscopic total resection of disseminated nodules. World J Surg. 2009;33:1425–31.
Masaoka A, Monden Y, Nakahara K, Tanioka T. Follow-up study of thymomas with special reference to their clinical stages. Cancer. 1981;48:2485–92.
Okumura M, Ohta M, Tateyama H, et al. The World Health Organization histologic classification system reflects the oncologic behavior of thymoma. Cancer. 2002;94:624–32.
Dindo D, Demartines N, Clavien P-A. Classification of surgical complications. Ann Surg. 2004;240:205–13.
Fabre D, Fadel E, Mussot S, et al. Long-term outcome of pleuropneumonectomy for Masaoka stage IVa thymoma. Eur J Cardiothorac Surg. 2011;39:e133–8.
Huang J, Rizk NP, Travis WD, et al. Feasibility of multimodality therapy including extended resections in stage IVA thymoma. J Thorac Cardiovasc Surg. 2007;134:1477–83; discussion 1483–1484.
Yang HC, Yoon YS, Kim HK, et al. En bloc extended total thymectomy and extrapleural pneumonectomy in Masaoka stage IVA thymomas. J Cardiothorac Surg. 2011;6:28.
Okuda K, Yano M, Yoshino I, et al. Thymoma patients with pleural dissemination: nationwide retrospective study of 136 cases in Japan. Ann Thorac Surg. 2014;97:1743–8.
Marulli G, Margaritora S, Lucchi M, et al. Surgical treatment of recurrent thymoma: is it worthwhile? Eur J Cardiothorac Surg. 2016;49:327–32.
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;1:75.
Kashima J, Okuma Y, Murata, Watanabe K, Hosomi Y, Hishima T. Chemoradiotherapy for unresectable cases of thymic epithelial tumors: a retrospective study. J Thorac Dis. 2017;9:3911–8.
Hishida T, Nomura S, Yano M, et al. Long-term outcome and prognostic factors of surgically treated thymic carcinoma: results of 306 cases from a Japanese Nationwide Database Study. Eur J Cardiothorac Surg. 2016;49(3): 835–841.
Kanzaki R, Kanou T, Ose N, 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;28:360–7.
Kobayashi Y, Fujii Y, Yano M, et al. Preoperative steroid pulse therapy for invasive thymoma: clinical experience and mechanism of action. Cancer. 2006;106:1901–7.
Kimura T, Inoue M, Kadota Y, et al. The oncological feasibility and limitations of video-assisted thoracoscopic thymectomy for early-stage thymomas. Eur J Cardiothorac Surg. 2013;44:e214–8.
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
DISCLOSURE
There are no conflicts of interest.
Additional information
Publisher's Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Electronic supplementary material
Below is the link to the electronic supplementary material.
Supplementary Fig. 1.
The overall survival of all patients (n=38) according to performance of repeat resection for thymoma pleural dissemination. Patients who underwent repeat resection showed a better prognosis than those who did not (p=0.005). (PDF 46 kb)
Rights and permissions
About this article
Cite this article
Kimura, K., Kanzaki, R., Kimura, T. et al. Long-Term Outcomes After Surgical Resection for Pleural Dissemination of Thymoma. Ann Surg Oncol 26, 2073–2080 (2019). https://doi.org/10.1245/s10434-019-07330-x
Received:
Published:
Issue Date:
DOI: https://doi.org/10.1245/s10434-019-07330-x