Introduction:
Thymus tumors are rare malignancies of unknown etiology, localized in the anterior mediastinum and highly correlated with an incidental diagnosis and asymptomatic progress. Complete tumor resection represents the standard therapy with the best prognosis and is directly associated with tumor size and extension. In our study we performed a retrospective comparative analysis of all benign and malignant thymic processes resected in our institution via sternotomy (S), thoracotomy (T) and VATS.
Methods:
From 2000 to 2017, a total of 212 (118♀/94♂) patients with benign and malignant thymic processes undergoing surgical resections were included in our study. A descriptive statistical multivariable analysis was performed in order to evaluate the age, gender, histological and clinical correlation between thymus tumors, recommended surgical approach and perioperative morbidity.
Results:
The postoperative histology revealed the following distribution: thymoma WHO A, AB, B 46.5%, thymoma WHO C 7%, thymus hyperplasia 20.7%, thymic and non-thymic cysts 10,8%, residual thymus 8%. VATS was the most commonly used surgical approach for residual thymus, thymic and non-thymic cysts, thymus hyperplasia and thymoma WHO A, AB and B, whereas the conventional sternotomy was the standard therapy in large tumors, advanced thymoma WHO C and other malignant non-thymic tumors. Interestingly, the predilection of the performed VATS/T/S (113/24/75) showed a gaussian distribution over the last two decades with a peak in both sternotomy and VATS group in 2005 – 2006 and 2015 – 2016, respectively.
Conclusion:
Our results emphasize the central role of VATS in the most benign thymic processes of the ventral mediastinum, in early stages of thymomas as well as in middle-aged patients and female subgroup. However, conventional sternotomy has proven its objective benefits in selected cases including large tumors, advanced thymoma stages and non-thymic carcinomas.
