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.
Similar content being viewed by others
References
Cohen AJ, Thompson L, Edwards FH, Bellamy RF (1991) Primary cysts and tumors of the mediastinum. Ann Thorac Surg 51:378–386
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
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
Hamaji M, Ali SO, Burt BM (2015) A meta-analysis of induction therapy for advanced thymic epithelial tumors. Ann Thorac Surg 99:1848–1856
Keynes G (1946) The surgery of the thymus gland. Br J Surg 33:201–214
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
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
Shapiro M, Korst RJ (2014) Surgical approaches for stage IVA thymic epithelial tumors. Front Oncol 3:332
Riely GJ, Huang J (2010) Induction therapy for locally advanced thymoma. J Thorac Oncol 5:S323–S326
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
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
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
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
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
Sugarbaker DJ (1993) Thoracoscopy in the management of anterior mediastinal masses. Ann Thorac Surg 56:653–656
Coosemans W, Lerut TE, Van Raemdonck DE (1993) Thoracoscopic surgery: the Belgian experience. Ann Thorac Surg 56:721–730
Kaiser LR (1994) Thymoma. The use of minimally invasive resection techniques. Chest Surg Clin N Am 4:185–194
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
Tomulescu V, Popescu I (2012) Unilateral extended thoracoscopic thymectomy for nontumoral myasthenia gravis—a new standard. Semin Thoracic Surg 24:115–122
Rückert JC, Czyzewski D, Pest S, Müller JM (2000) Radicality of thoracoscopic thymectomy—an anatomical study. Eur J Cardiothorac Surg 18:735–736
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
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
Li Y, Wang J (2014) Left-sided approach video-assisted thymectomy for the treatment of thymic diseases. World J Surg Oncol 12:398
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
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
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
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
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
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
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
Odaka M, Tsukamoto Y, Shibasaki T et al (2017) Surgical and oncological outcomes of thoracoscopic thymectomy for thymoma. J Vis Surg 10:54
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
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
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
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
Scarci M, Pardolesi A, Solli P (2015) Uniportal video-assisted thoracic surgery thymectomy. Ann Cardiothorac Surg 4:567–570
Liu Z, Yang R, Sun Y (2019) Non-intubated subxiphoid uniportal video-assisted thoracoscopic thymectomy. Interact Cardiovasc Thorac Surg 29:742–745
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
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
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
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
Rueckert J, Swierzy M, Badakhshi H et al (2015) Robotic-assisted thymectomy: surgical procedure and results. Thorac Cardiovasc Surg 63:194–200
Suda T (2016) Robotic subxiphoid thymectomy. J Vis Surg 2:118
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
Ismail M, Swierzy M, Ruckert JC (2013) State of the art of robotic thymectomy. World J Surg 37:2740–2746
Ismail M, Swierzy M, Rückert RI, Rückert JC (2014) Robotic thymectomy for myasthenia gravis. Thorac Surg Clin 24:189–195
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
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
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
Keijzers M, Dingemans AC, Blaauwgeers H et al (2014) 8 years’ experience with robotic thymectomy for thymomas. Surg Endosc 28:1202–1208
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
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
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
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
Suda T, Ashikari S, Tochii D, Tochii S, Takagi Y (2014) Dual-port thymectomy using subxiphoid approach. Gen Thorac Cardiovasc Surg 62:570–572
Suda T, Tochii D, Tochii S, Takagi Y (2015) Trans-subxiphoid robotic thymectomy. Interact Cardiovasc Thorac Surg 20:669–671
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
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
Keesey JC (2004) A history of treatments for myasthenia gravis. Semin Neurol 24:5–16
Papatestas AE, Genkins G, Kornfeld P et al (1987) Effects of thymectomy in myasthenia gravis. Ann Surg 206:79–88
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
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
Zieliński M (2000) Technique of transcervical--subxiphoid-vats “maximal” thymectomy in treatment of myasthenia gravis. Przegl Lek 57:64–65
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
DeFilippi VJ, Richman DP, Ferguson MK (1994) Transcervical thymectomy for myasthenia gravis. Ann Thorac Surg 57:194–197
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
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
Donahoe L, Keshavjee S (2015) Video-assisted transcervical thymectomy for myasthenia gravis. Ann Cardiothorac Surg 4:561–563
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
Author information
Authors and Affiliations
Corresponding author
Additional information
Publisher’s Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Rights and permissions
About this article
Cite this article
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
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s13193-020-01208-1