Surgical management of locally advanced thymomas

<bold>Introduction:</bold> Thymic tumors present challenges requiring a multidisciplinary approach. Locally advanced thymomas (LAT) demand specialized surgical expertise and collaborative decision-making. This study aims to analyze the epidemiology, clinical profiles, and outcomes of LAT surgery. <bold>Methods:</bold> This was a retrospective cohort including patients operated for LAT (initially classified as MASOKA III or IV) in our department, from January 2012 to June 2022. <bold>Results:</bold> We included 17 LAT cases (51% of thymoma surgeries and 44% of mediastinal tumors) with 12 women (70%) and 5 mans (30%), a sex ratio of 0.4 and an average age of 48 years. Myasthenia revealed LAT in 59%. All patients were classified as MASOKA III with pericardium, lung, phrenic nerve, and great vessels invasion in 15, 6, 5, and 2 cases respectively. Median sternotomy was used in 15 patients and two had uniportal VATS resection. All patients had total thymectomy extended to mediastinal fat and to invaded structures. We performed 10 pericardial reconstructions, 6 pulmonary resections (5 wedge resections and 1 lobectomy). Otherwise, the phrenic nerve was sacrificed in 7 cases. Postoperative complications occurred in 18% of cases (especially respiratory complications for myasthenic patients) One patient died due to pulmonary embolism. Average tumor size was 5.6 cm. Complete resection (83%) mostly B2 and B3 subtypes (82%) was confirmed on pathology. No local recurrence or deaths occurred during a 14-month postoperative follow-up. <bold>Conclusion:</bold> Surgical management of LAT requires a multidisciplinary approach. Minimally invasive approaches are effective in achieving favorable outcomes and good survival rates