Long-term follow-up of non-myasthenic patients with early-stage thymoma who underwent extended thymectomy or limited resection

Ping-Chung Tsai; Yen-Chiang Tseng; Ying-Che Ting; Chien-Sheng Huang; Wen-Hu Hsu; En-Kuei Tang; Han-Shui Hsu

doi:10.1016/j.ejso.2024.108349

Long-term follow-up of non-myasthenic patients with early-stage thymoma who underwent extended thymectomy or limited resection

Eur J Surg Oncol. 2024 Apr 16;50(6):108349. doi: 10.1016/j.ejso.2024.108349. Online ahead of print.

Authors

Ping-Chung Tsai¹, Yen-Chiang Tseng¹, Ying-Che Ting², Chien-Sheng Huang³, Wen-Hu Hsu³, En-Kuei Tang⁴, Han-Shui Hsu⁵

Affiliations

¹ Division of Thoracic Surgery, Department of Surgery, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan; Institute of Emergency and Critical Care Medicine, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan.
² Division of Thoracic Surgery, Department of Surgery, Taipei Veterans General Hospital, Taipei, Taiwan.
³ Institute of Emergency and Critical Care Medicine, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan; Division of Thoracic Surgery, Department of Surgery, Taipei Veterans General Hospital, Taipei, Taiwan.
⁴ Division of Thoracic Surgery, Department of Surgery, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan.
⁵ Institute of Emergency and Critical Care Medicine, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan; Division of Thoracic Surgery, Department of Surgery, Taipei Veterans General Hospital, Taipei, Taiwan. Electronic address: hsuhs@vghtpe.gov.tw.

PMID: 38640605
DOI: 10.1016/j.ejso.2024.108349

Abstract

Backgroud: The standard resection for early-stage thymoma is total thymectomy and complete tumour excision with or without myasthenia gravis but the optimal surgery mode for patients with early-stage non-myasthenic thymoma is debatable. This study analysed the oncological outcomes for non-myasthenic patients with early-stage thymoma treated by thymectomy or limited resection in the long term.

Methods: Patients who had resections of thymic neoplasms at Taipei Veteran General Hospital, Taiwan between December 1997 and March 2013 were recruited, exclusive of those combined clinical evidence of myasthenia gravis were reviewed. A total of 113 patients were retrospectively reviewed with pathologic early stage (Masaoka stage I and II) thymoma who underwent limited resection or extended thymectomy to compare their long-term oncologic and surgical outcomes.

Results: The median observation time was 134.1 months [interquartile range (IQR) 90.7-176.1 months]. In our cohort, 52 patients underwent extended thymectomy and 61 patients underwent limited resection. Shorter duration of surgery (p < 0.001) and length of stay (p = 0.006) were demonstrated in limited resection group. Six patients experienced thymoma recurrence, two of which had combined myasthenia gravis development after recurrence. There was no significant difference (p = 0.851) in freedom-from-recurrence, with similar 10-year freedom-from-recurrence rates between the limited resection group (96.2 %) and the thymectomy group (93.2 %). Tumour-related survival was also not significantly different between groups (p = 0.726).result CONCLUSION: Patients with early-stage non-myasthenic thymoma who underwent limited resection without complete excision of the thymus achieved similar oncologic outcomes during the long-term follow-up and better peri-operative results compared to those who underwent thymectomy.

Keywords: Extended thymectomy; Limited resection; Recurrence; Survival; Thymoma.