Resection of Giant Right-Sided Thymoma using a Lateral Thoracotomy Approach Followed by Median Sternotomy for Completion Thymectomy

Introduction

The most commonly utilized surgical approach for the resection of a thymoma is a median sternotomy. The goal of surgery is to remove the thymoma together with complete resection of the thymus gland [[6]]. In our case, we were confronted with a stage I thymoma of remarkable size and location which did not allow us to resect the lesion in a single-step approach via a median sternotomy. A lateral thoracotomy was performed, followed by a separate median sternotomy in order to resect the remnants of the thymus gland on the opposite side. Although mentioned in textbooks on thoracic surgery, the frequency of thoracotomy procedures for thymomas remains unknown.

References

• 1 Masaoka A, Mondem Y, Nakahara K. et al . Follow-up study of thymomas with special reference to their clinical stage.  Cancer. 1981;  48 2485-2492
• 2 Nakagawa K, Asamura H, Matsuno Y. et al . Thymoma: a clinicopathologic study based on the new World Health Organization classification.  J Thor Cardiovasc Surg. 2003;  126 1134-1140
• 3 Detterbeck F, Parsons A. Thymic tumors.  Ann Thorac Surg. 2004;  77 1860-1869
• 4 Kirschner P A. The history of surgery of the thymus gland.  Chest Surg Clin N Am. 2000;  10 153-165
• 5 Port J L, Ginsberg R J. Surgery for thymoma.  Chest Surg Clin Am. 2001;  11 421-437
• 6 Thomas C R, Wright C D, Loehrer P J. Thymoma: state of the art.  J Clin Oncol. 1999;  7 2280
• 7 Fechner R E. Recurrence of noninvasive thymomas.  Cancer. 1969;  23 1423-1427
• 8 Gamondes J P, Balawi A. et al . Seventeen years of surgical treatment of thymoma: factors influencing survival.  Eur J Cardiothorac Surg. 1991;  5 124-131
• 9 Wilkins E W, Grillo H C. et al . Role of staging in prognosis and management of thymoma.  Ann Thorac Surg. 1991;  51 888-892
• 10 Wright C, Wain J. et al . Predictors of recurrence in thymic tumors: importance of invasion, WHO histology, and size.  J Thorac Cardiovasc Surg. 2005;  130 1413-1421
• 11 Eng T, Thomas C. Radiation therapy in the management of thymic tumors. 2005 17: 32-40
• 12 Kirschner P A. Reoperation for thymoma: report of 23 cases.  Ann Thorac Surg. 1990;  49 550-555
• 13 Regnard J F, Magdeleinat P. et al . Prognostic factors and long-term results after thymoma resection: a series of 307 patients.  J Thorac Cardiovasc Surg. 1996;  112 376-384
• 14 Wright C D, Kessler K A. Surgical treatment of thymic tumors.  Semin Thorac Cardiovasc Surg. 2005;  17 20-26
• 15 Blumberg D, Port J L. et al . Thymoma: a multivariate analysis of factors predicting survival.  Ann Thorac Surg. 1995;  60 908-914