The Challenges of Managing Thymic Cancers

An Expert Interview With James Huang, MD, and Gregory J. Riely, MD, PhD

Shira Berman; James Huang, MD; Gregory J. Riely, MD, PhD

Disclosures

May 11, 2012

In This Article

Resection and Its Effect on Prognosis

Medscape: The first step in treatment for both of these tumors is to determine whether it is resectable. How does the prognosis change when we look at how much of the tumor is removed?

Dr. Huang: Time and time again, people have shown that the ability to achieve a complete resection -- where you don't leave any disease behind, either microscopic or gross disease -- is one of the most important prognostic factors in the outcomes of these patients.[3,4] Being able to resect the tumor is key. But this is something that is best judged by a surgeon who has a lot of experience with these rare tumors.

Sometimes [a tumor's resectability] is fairly obvious, but some of these tumors can be quite extensive and the question of resectability is not so straightforward.These are the cases that really deserve a multidisciplinary approach and consideration for combined-modality therapy.

Medscape: How well accepted is the use of minimally invasive surgery for these tumors?

Dr. Huang: We've gotten better with minimally invasive techniques. First with VATS (video-assisted thoracic surgery) for thoracoscopic approaches, and now with the advent of robotic technology and robotic-assisted thymectomies, I think more and more people are feeling more comfortable with these techniques.[5] They're realizing that, with minimally invasive approaches that have a scope or the 3-dimensional optics provided by a robot, the technology actually can give you a better view than you could have with open surgery.

Historically, we assumed that traditional open surgery was better because you were able to see things better and there was less risk for disruption or spillage of the tumor. However, for small lesions or indeterminate lesions, minimally invasive approaches could have a role, and more and more people are becoming more adept at doing them.

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