Alternative choices of total and partial thymectomy in video-assisted resection of noninvasive thymomas

The purpose of this report is to discuss the appropriate choice of procedures for video-assisted resection of thymoma according to factors such as the presence of myasthenia gravis or location of the tumor.

We evaluated the short-term results of thoracoscopic surgery for 30 consecutive cases of noninvasive thymoma. Unilateral thoracoscopic partial (or subtotal) thymectomy (UTPT) was employed in patients with nonmyasthenic thymoma localized to the unilateral mediastinum, and extended (or total) thymectomy by an infrasternal mediastinal approach (ETIS) in myasthenic cases or those in which total thymectomy was considered inevitable.

UTPT was performed on 11 nonmyasthenic patients, and ETIS on 19 (13 myasthenics and six nonmyasthenics). Three patients in the ETIS group underwent conversion to sternotomy because of pericardial dissemination, pleural adhesion, and vascular injury, respectively. The mean surgical duration was 163 min and 224 min and mean blood loss was 123 g versus 149 g for UTPT and ETIS, respectively. Post-thymomectomy myasthenia occurred in a patient after UTPT who made an excellent recovery to remission after the re-UTPT. There has not been any recurrence detected for 48 months of mean postoperative follow-up.

Our trial regarding the choice of total or partial thymectomy in thoracoscopic surgery for thymomas yielded acceptable results that warrant further investigations into long-term survival and recurrence after longer-term observation of patients undergoing these procedures.