Outcomes of combined operations for treatment of patients with locally advanced thymomas

Objective. Analysis of our own experience of combined thymectomy for locally advanced thymomas with a study of immediate and long-term results. Material and methods. The study included 28 patients with histologically confirmed locally advanced thymoma who underwent combined surgical interventions between September 2004 and December 2020. Results. Stage III according to Masaoka was 78.6% (22/28), IV — 21.4% (6/28). The distribution in accordance with the WHO classification was as follows: A — 10.7% (3/28), AB — 7.1% (2/28), B1 — 7.1% (2/28), B2 — 17.8 % (5/28), B3 — 10.7% (3/28), C — 46.4% (13/28). The prevalence of the primary tumor was: T2 — 28.6% (8/28), T3 — 60.7% (17/28), T4 — 10.7% (3/28). The most common sites of tumor invasion were the pericardium, lung, brachiocephalic vein, and superior vena cava. The median duration of surgery was 220 minutes, intraoperative blood loss was 300 ml, the duration of pleural drainage was 3 days, and hospitalization was 14 days. 5-year disease-specific survival for Masaoka stage III was 89.4% and relapse free survival was 59.8%, 10-year — 67.1% and 41.0%, respectively. Median sternotomy was used for 8 (28.6%) patients, partial cervicosternotomy — 2 (7.1%), and thoracotomy — 10 (35.7%). VATS thymectomy with pericardial resection was performed in 6 (21.4%) patients, lung — 3 (10.7%), phrenic nerve — 1 (3.6%), marginal resection of the left brachiocephalic vein — 1 (3.6%). Conclusions. Combined thymectomy is an effective treatment for Masaoka stage III thymoma, yielding satisfactory long-term survival. In case of thymoma invasion into the lung, pericardium or brachiocephalic vein, combined VATS thymectomy with resection of involved structures is feasible in carefully selected patients.