Which surgical procedures are used in the treatment of thymoma?

Updated: Jul 27, 2020
  • Author: Kendrix J Evans, MD, MS; Chief Editor: John Geibel, MD, MSc, DSc, AGAF  more...
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Answer

Although the preferred approach is a median sternotomy to provide adequate exposure of the mediastinal structures and allowing complete removal of the thymus, the cervical approach also is adequate.

If the tumor is small and appears readily accessible, perform a total thymectomy with contiguous removal of mediastinal fat. If the tumor is invasive, perform a total thymectomy in addition to en-bloc removal of involved pericardium, pleura, lung, phrenic nerve, innominate vein, or superior vena cava. Resect one phrenic nerve; however, if both phrenic nerves are involved, do not resect either one, and debulk the area. Clip areas of close margins or residual disease to assist the radiation oncologist in treatment planning.

Controversy persists with regard to whether biopsy or subtotal excision is superior for treating unresectable tumors. Some studies have supported subtotal excision, whereas others have shown no difference between the two modalities. A generally accepted rule is that patients with invasive or residual disease should receive adjuvant therapy.


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