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Minimal Access Surgery for Thymoma

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Abstract

Thymoma is a rare epithelial tumor of the thymus gland. Despite rarity, it is the most common tumor of the anterior mediastinum. Surgical resection in the form of extended thymectomy is the gold standard operation. Conventionally and even in the current era of significant advances in the minimally invasive surgery, open transsternal extended thymectomy is considered the gold standard, particularly for advanced-stage tumors. There is however significant evidence now available for the use of minimally invasive approaches for early-stage thymomas. This article aims to discuss the various minimally invasive approaches currently being employed for thymomas.

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References

  1. Cohen AJ, Thompson L, Edwards FH, Bellamy RF (1991) Primary cysts and tumors of the mediastinum. Ann Thorac Surg 51:378–386

    CAS  PubMed  Google Scholar 

  2. Girard N, Ruffini E, Marx A, Faivre-Finn C, Peters S, ESMO Guidelines Committee (2015) ESMO guidelines committee. Thymic epithelial tumours: ESMO clinical practice guidelines for diagnosis, treatment and follow-up. Ann Oncol 26:v40–v55

    PubMed  Google Scholar 

  3. Falkson CB, Bezjak A, Darling G, Gregg R, Malthaner R, Maziak DE, Yu E, Smith CA, McNair S, Ung YC, Evans WK, Lung Cancer Disease Site Group of Cancer Care Ontario's Program in Evidence-Based Care (2009) The management of thymoma: a systematic review and practice guideline. J Thorac Oncol 4:911–919

    PubMed  Google Scholar 

  4. Hamaji M, Ali SO, Burt BM (2015) A meta-analysis of induction therapy for advanced thymic epithelial tumors. Ann Thorac Surg 99:1848–1856

    PubMed  Google Scholar 

  5. Keynes G (1946) The surgery of the thymus gland. Br J Surg 33:201–214

    CAS  PubMed  Google Scholar 

  6. Xie A, Richard T, Kevin P et al (2015) Video-assisted thoracoscopic surgery versus open thymectomy for thymoma: systematic review. Ann Cardiothorac Surg 4:495–508

    PubMed  PubMed Central  Google Scholar 

  7. Venuta F, Rendina EA, Anile M, de Giacomo T, Vitolo D, Coloni GF (2012) Thymoma and thymic carcinoma. Gen Thorac Cardiovasc Surg 60:1–12

    PubMed  Google Scholar 

  8. Shapiro M, Korst RJ (2014) Surgical approaches for stage IVA thymic epithelial tumors. Front Oncol 3:332

    PubMed  PubMed Central  Google Scholar 

  9. Riely GJ, Huang J (2010) Induction therapy for locally advanced thymoma. J Thorac Oncol 5:S323–S326

    PubMed  Google Scholar 

  10. Toker A, Sonnett J, Zielinski M et al (2011) Standard terms, definitions and policies for minimally invasive resection of thymoma. J Thor Oncol 6:S1739–S1742

    Google Scholar 

  11. Pennathur A, Qureshi I, Schuchert MJ, Dhupar R, Ferson PF, Gooding WE, Christie NA, Gilbert S, Shende M, Awais O, Greenberger JS, Landreneau RJ, Luketich JD (2011) Comparison of surgical techniques for early-stage thymoma: feasibility of minimally invasive thymectomy and comparison with open resection. J Thorac Cardiovasc Surg 141:694–701

    PubMed  Google Scholar 

  12. Huang J, Ahmad U, Antonicelli A, Catlin AC, Fang W, Gomez D, Loehrer P, Lucchi M, Marom E, Nicholson A, Ruffini E, Travis W, van Schil P, Wakelee H, Yao X, Detterbeck F (2014) Development of the international thymic malignancy interest group international database: an unprecedented resource for the study of a rare group of tumors. J Thorac Oncol 9:1573–1578

    PubMed  Google Scholar 

  13. Gronseth GS, Barohn RJ (2000) Practice parameter: thymectomy for autoimmune myasthenia gravis (an evidence-based review): report of the Quality Standards Subcommittee of the American Academy of Neurology. Neurology 55:7–15

    CAS  PubMed  Google Scholar 

  14. Zahid I, Sharif S, Routledge T, Scarci M (2011) Video-assisted thoracoscopic surgery or transsternal thymectomy in the treatment of myasthenia gravis? Interact Cardiovasc Thorac Surg 12:40–46

    PubMed  Google Scholar 

  15. Sugarbaker DJ (1993) Thoracoscopy in the management of anterior mediastinal masses. Ann Thorac Surg 56:653–656

    CAS  PubMed  Google Scholar 

  16. Coosemans W, Lerut TE, Van Raemdonck DE (1993) Thoracoscopic surgery: the Belgian experience. Ann Thorac Surg 56:721–730

    CAS  PubMed  Google Scholar 

  17. Kaiser LR (1994) Thymoma. The use of minimally invasive resection techniques. Chest Surg Clin N Am 4:185–194

    CAS  PubMed  Google Scholar 

  18. Agatsuma H, Yoshida K, Yoshino I, Okumura M, Higashiyama M, Suzuki K, Tsuchida M, Usuda J, Niwa H (2017) Video-assisted thoracic surgery thymectomy versus sternotomy thymectomy in patients with thymoma. Ann Thorac Surg 104:1047–1053

    PubMed  Google Scholar 

  19. Tomulescu V, Popescu I (2012) Unilateral extended thoracoscopic thymectomy for nontumoral myasthenia gravis—a new standard. Semin Thoracic Surg 24:115–122

    Google Scholar 

  20. Rückert JC, Czyzewski D, Pest S, Müller JM (2000) Radicality of thoracoscopic thymectomy—an anatomical study. Eur J Cardiothorac Surg 18:735–736

    PubMed  Google Scholar 

  21. Toker A, Tanju S, Sungur Z, Parman Y, Senturk M, Serdaroglu P, Dilege S, Deymeer F (2008) Videothoracoscopic thymectomy for nonthymomatous myasthenia gravis: results of 90 patients. Surg Endosc 22:912–916

    PubMed  Google Scholar 

  22. Mineo TC, Pompeo E, Lerut TE, Bernardi G, Coosemans W, Nofroni I (2000) Thoracoscopic thymectomy in autoimmune myasthesia: results of left-sided approach. Ann Thorac Surg 69:1537–1541

    CAS  PubMed  Google Scholar 

  23. Li Y, Wang J (2014) Left-sided approach video-assisted thymectomy for the treatment of thymic diseases. World J Surg Oncol 12:398

    PubMed  PubMed Central  Google Scholar 

  24. Nakagawa K, Yokoi K, Nakajima J, Tanaka F, Maniwa Y, Suzuki M, Nagayasu T, Asamura H (2016) Is Thymomectomy alone appropriate for stage I (T1N0M0) thymoma? Results of a propensity-score analysis. Ann Thorac Surg 101:520–526

    PubMed  Google Scholar 

  25. Gu Z, Fu J, Shen Y, Wei Y, Tan L, Zhang P, Han Y, Chen C, Zhang R, Li Y, Chen K, Chen H, Liu Y, Cui Y, Wang Y, Pang L, Yu Z, Zhou X, Liu Y, Liu Y, Fang W, Members of the Chinese Alliance for Research in Thymomas (2016) Members of the Chinese Alliance for Research in Thymomas. Thymectomy versus tumor resection for early-stage thymic malignancies: a Chinese Alliance for Research in Thymomas retrospective database analysis. J Thorac Dis 8:680–686

    PubMed  PubMed Central  Google Scholar 

  26. Narm KS, Lee CY, Do YW, Jung HS, Byun GE, Lee JG, Kim DJ, Hwang Y, Park IK, Kang CH, Kim YT, Cho JH, Choi YS, Kim J, Shim YM, Hwang SK, Kim YH, Kim DK, Park SI, Chung KY, Korea Association for Research on the Thymus (2016) Limited thymectomy as a potential alternative treatment option for early-stage thymoma: a multi-institutional propensity-matched study. Lung Cancer 101:22–27

    PubMed  Google Scholar 

  27. Marulli G, Rea F, Melfi F, Schmid TA, Ismail M, Fanucchi O, Augustin F, Swierzy M, di Chiara F, Mussi A, Rueckert JC (2012) Robot-aided thoracoscopic thymectomy for early-stage thymoma: a multicenter European study. J Thorac Cardiovasc Surg 144:1125–1130

    PubMed  Google Scholar 

  28. Takeo S, Tsukamoto S, Kawano D, Katsura M (2011) Outcome of an original video assisted thoracoscopic extended thymectomy for thymoma. Ann Thorac Surg 92:2000–2005

    PubMed  Google Scholar 

  29. Burt BM, Yao X, Shrager J, Antonicelli A, Padda S, Reiss J, Wakelee H, Su S, Huang J, Scott W (2017) Determinants of complete resection of thymoma by minimally invasive and open thymectomy: analysis of an international registry. J Thorac Oncol 12:129–136

    PubMed  Google Scholar 

  30. Hess NR, Sarkaria IS, Pennathur A, Levy RM, Christie NA, Luketich JD (2016) Minimally invasive versus open thymectomy: a systematic review of surgical techniques, patient demographics, and perioperative outcomes. Ann Cardiothorac Surg 5:1–9

    PubMed  PubMed Central  Google Scholar 

  31. Odaka M, Tsukamoto Y, Shibasaki T et al (2017) Surgical and oncological outcomes of thoracoscopic thymectomy for thymoma. J Vis Surg 10:54

    Google Scholar 

  32. Kimura T, Inoue M, Kadota Y, Shiono H, Shintani Y, Nakagiri T, Funaki S, Sawabata N, Minami M, Okumura M (2013) The oncological feasibility and limitations of video-assisted thoracoscopic thymectomy for early-stage thymomas. Eur J Cardiothorac Surg 44:e214–e218

    PubMed  Google Scholar 

  33. Wang H, Gu Z, Ding J et al (2016) Members of the Chinese Alliance for Research in Thymomas. Perioperative outcomes and long-term survival in clinically early-stage thymic malignancies: video-assisted thoracoscopic thymectomy versus open approaches. J Thorac Dis 8:673–679

    PubMed  PubMed Central  Google Scholar 

  34. Wang GW, Tao T, Li CK, Li QC, Duan GX, Sang HW, Dong HJ, Wang ZY (2019) Comparison between thoracoscopic and open approaches in thymoma resection. J Thorac Dis 11:4159–4168

    PubMed  PubMed Central  Google Scholar 

  35. Xu N, Gu Z, Ji C, Zhang X, Chen T, Fang W (2019) Thoracoscopic thymectomy with partial superior vena cava resection for locally advanced thymomas. J Thorac Dis 11:438–444

    PubMed  PubMed Central  Google Scholar 

  36. Scarci M, Pardolesi A, Solli P (2015) Uniportal video-assisted thoracic surgery thymectomy. Ann Cardiothorac Surg 4:567–570

    PubMed  PubMed Central  Google Scholar 

  37. Liu Z, Yang R, Sun Y (2019) Non-intubated subxiphoid uniportal video-assisted thoracoscopic thymectomy. Interact Cardiovasc Thorac Surg 29:742–745

    PubMed  Google Scholar 

  38. Jiang L, Liu J, Shao W, Li J, He J (2016) Non-intubated subxiphoid uniportal video-assisted thoracoscopic thymectomy using glasses-free 3D vision. J Thorac Dis 8:E1602–E1604

    PubMed  PubMed Central  Google Scholar 

  39. Yoshino I, Hashizume M, Shimada M, Tomikawa M, Tomiyasu M, Suemitsu R, Sugimachi K (2001) Thoracoscopic thymomectomy with the da Vinci computer-enhanced surgical system. J Thorac Cardiovasc Surg 122:783–785

    CAS  PubMed  Google Scholar 

  40. Rea F, Bortolotti L, Girardi R et al (2003) Thoracoscopic thymectomy with the ‘da Vinci’ surgical system in patient with myasthenia gravis. Interact Cardiovasc Thorac Surg 2:70–72

    PubMed  Google Scholar 

  41. Marulli G, Schiavon M, Perissinotto E, Bugana A, di Chiara F, Rebusso A, Rea F (2013) Surgical and neurologic outcomes after robotic thymectomy in 100 consecutive patients with myasthenia gravis. J Thorac Cardiovasc Surg 145:730–736

    PubMed  Google Scholar 

  42. Rueckert J, Swierzy M, Badakhshi H et al (2015) Robotic-assisted thymectomy: surgical procedure and results. Thorac Cardiovasc Surg 63:194–200

    PubMed  Google Scholar 

  43. Suda T (2016) Robotic subxiphoid thymectomy. J Vis Surg 2:118

    PubMed  PubMed Central  Google Scholar 

  44. Cerfolio RJ, Bryant AS, Minnich DJ (2011) Starting a robotic program in general thoracic surgery: why, how, and lessons learned. Ann Thorac Surg 91:1729–1736

    PubMed  Google Scholar 

  45. Ismail M, Swierzy M, Ruckert JC (2013) State of the art of robotic thymectomy. World J Surg 37:2740–2746

    PubMed  Google Scholar 

  46. Ismail M, Swierzy M, Rückert RI, Rückert JC (2014) Robotic thymectomy for myasthenia gravis. Thorac Surg Clin 24:189–195

    PubMed  Google Scholar 

  47. Mineo TC, Pompeo E, Ambrogi V (1997) Video-assisted thoracoscopic thymectomy: from the right or from the left? J Thorac Cardiovasc Surg 114:516–517

    CAS  PubMed  Google Scholar 

  48. Toker A, Erus S, Ozkan B, Ziyade S, Tanju S (2011) Does a relationship exist between the number of thoracoscopic thymectomies performed and the learning curve for thoracoscopic resection of thymoma in patients with myasthenia gravis? Interact Cardiovasc Thorac Surg 12:152–155

    PubMed  Google Scholar 

  49. Marulli G, Maessen J, Melfi F, Schmid TA, Keijzers M, Fanucchi O, Augustin F, Comacchio GM, Mussi A, Hochstenbag M, Rea F (2016) Multi-institutional European experience of robotic thymectomy for thymoma. Ann Cardiothorac Surg 5:18–25

    PubMed  PubMed Central  Google Scholar 

  50. Keijzers M, Dingemans AC, Blaauwgeers H et al (2014) 8 years’ experience with robotic thymectomy for thymomas. Surg Endosc 28:1202–1208

    PubMed  Google Scholar 

  51. Kneuertz PJ, Kamel MK, Stiles BM, Lee BE, Rahouma M, Nasar A, Altorki NK, Port JL (2017) Robotic thymectomy is feasible for large Thymomas: a propensity-matched comparison. Ann Thorac Surg 104:1673–1678

    PubMed  Google Scholar 

  52. O'Sullivan KE, Kreaden US, Hebert AE et al (2019) A systematic review of robotic versus open and video assisted thoracoscopic surgery (VATS) approaches for thymectomy. Ann Cardiothorac Surg 8:174–193

    PubMed  PubMed Central  Google Scholar 

  53. Marulli G, Comacchio GM, Schiavon M, Rebusso A, Mammana M, Zampieri D, Perissinotto E, Rea F (2018) Comparing robotic and trans-sternal thymectomy for early-stage thymoma: a propensity score-matching study. Eur J Cardiothorac Surg 54:579–584

    PubMed  Google Scholar 

  54. Suda T, Sugimura H, Tochii D, Kihara M, Hattori Y (2012) Single-port thymectomy through an infra-sternal approach. Ann Thorac Surg 93:334–336

    PubMed  Google Scholar 

  55. Suda T, Ashikari S, Tochii D, Tochii S, Takagi Y (2014) Dual-port thymectomy using subxiphoid approach. Gen Thorac Cardiovasc Surg 62:570–572

    PubMed  Google Scholar 

  56. Suda T, Tochii D, Tochii S, Takagi Y (2015) Trans-subxiphoid robotic thymectomy. Interact Cardiovasc Thorac Surg 20:669–671

    PubMed  Google Scholar 

  57. Suda T Subxiphoid robotic extended thymectomy with a pericardial patch closure. CTSNet. Available online: http://www.ctsnet.org/article/subxiphoid-roboticextended-thymectomy-pericardial-patch-closure. Accessed 4 April 2022

  58. Asaf BB, Puri HV, Bishnoi S, Nanda NS, Pulle MV, Kumar A (2019) Subxiphoid robotic extended thymectomy - the first Indian report. J Minim Access Surg 0:0. https://doi.org/10.4103/jmas.JMAS_34_19

    Article  Google Scholar 

  59. Keesey JC (2004) A history of treatments for myasthenia gravis. Semin Neurol 24:5–16

    PubMed  Google Scholar 

  60. Papatestas AE, Genkins G, Kornfeld P et al (1987) Effects of thymectomy in myasthenia gravis. Ann Surg 206:79–88

    CAS  PubMed  PubMed Central  Google Scholar 

  61. Cooper JD, Al-Jilaihawa AN, Pearson FG et al (1988) An improved technique to facilitate transcervical thymectomy for myasthenia gravis. Ann Thorac Surg 45:242–247

    CAS  PubMed  Google Scholar 

  62. Novellino L, Longoni M, Spinelli L, Andretta M, Cozzi M, Faillace G, Vitellaro M, de Benedetti D, Pezzuoli G (1994) “Extended” thymectomy, without sternotomy, performed by cervicotomy and thoracoscopic technique in the treatment of myasthenia gravis. Int Surg 79:378–381

    CAS  PubMed  Google Scholar 

  63. Zieliński M (2000) Technique of transcervical--subxiphoid-vats “maximal” thymectomy in treatment of myasthenia gravis. Przegl Lek 57:64–65

    PubMed  Google Scholar 

  64. de Perrot M, Bril V, McRae K, Keshavjee S (2003) Impact of minimally invasive trans-cervical thymectomy on outcome in patients with myasthenia gravis. Eur J Cardiothorac Surg 24:677–683

    PubMed  Google Scholar 

  65. DeFilippi VJ, Richman DP, Ferguson MK (1994) Transcervical thymectomy for myasthenia gravis. Ann Thorac Surg 57:194–197

    CAS  PubMed  Google Scholar 

  66. Calhoun RF, Ritter JH, Guthrie TJ, Pestronk A, Meyers BF, Patterson GA, Pohl MS, Cooper JD (1999) Results of transcervical thymectomy for myasthenia gravis in 100 consecutive patients. Ann Surg 230:555–561

    CAS  PubMed  PubMed Central  Google Scholar 

  67. Shrager JB, Deeb ME, Mick R, Brinster CJ, Childers HE, Marshall MB, Kucharczuk JC, Galetta SL, Bird SJ, Kaiser LR (2002) Transcervical thymectomy for myasthenia gravis achieves results comparable to thymectomy by sternotomy. Ann Thorac Surg 74:320–327

    PubMed  Google Scholar 

  68. Donahoe L, Keshavjee S (2015) Video-assisted transcervical thymectomy for myasthenia gravis. Ann Cardiothorac Surg 4:561–563

    PubMed  PubMed Central  Google Scholar 

  69. Zieliński M, Rybak M, Solarczyk-Bombik K, Wilkojc M, Czajkowski W, Kosinski S, Fryzlewicz E, Nabialek T, Szolkowska M, Pankowski J (2018) Transcervical thymectomy. Mediastinum 2:28

    Google Scholar 

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Kumar, A., Asaf, B.B., Pulle, M.V. et al. Minimal Access Surgery for Thymoma. Indian J Surg Oncol 11, 625–632 (2020). https://doi.org/10.1007/s13193-020-01208-1

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