What is the role of surgery in the treatment of thymoma?

Updated: Dec 03, 2018
  • Author: Kendrix J Evans, MD, MS; Chief Editor: John Geibel, MD, MSc, DSc, AGAF  more...
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Answer

In most cases of thymoma, initial management is surgical. [7, 11] Surgical excision provides the histologic characteristics of the tumor and provides staging information that helps determine the need for adjuvant therapy. Small and encapsulated thymomas are excised for diagnosis and treatment. In the past, obtaining a preoperative biopsy of large invasive thymomas was shunned for fear of local implantation of tumor cells. Currently, biopsies are performed for these atypical tumors to discover the histology of the tumor and to ascertain its invasive potential.

A single-institution retrospective study was conducted of five patients with stage IVA thymoma treated with pleuropneumonectomy. [14] The median survival was 86 months, and the Kaplan-Meier survival was 75% at 5 years and 50% at 10 years. There was no operative mortality in this study. It has been suggested that in select patients, this approach after a complete resection and neoadjuvant chemotherapy may be promising. [14]

The prognosis for a thymoma patient is based on the tumor's gross characteristics at operation, not its histologic appearance. Benign tumors are noninvasive and encapsulated. Conversely, malignant tumors are defined by local invasion into the thymic capsule or surrounding tissue. As noted (see Staging), the Masaoka system is the most commonly accepted staging system for thymomas.

Although controversy exists regarding the use of postoperative radiation for invasive thymomas, the preponderance of evidence indicates that all thymomas, except completely encapsulated stage I tumors, benefit from adjuvant radiation therapy. [2]


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