The role of surgical management in recurrent thymic tumors

There are few data on outcomes after surgical treatment for recurrent thymic tumors. The aim of this study is to analyze and compare long-term outcomes of treatments for recurrent thymic tumors.

Between January 1956 and December 2009, 344 thymic tumors were surgically resected (309 thymomas, 22 thymic carcinomas, 12 thymic carcinoids, and 1 thymolipoma). There were 48 recurrences (13.9%): 30 thymomas, 9 thymic carcinomas, and 9 thymic carcinoids. There were 27 men and 21 women with a median age of 51 years (range, 27 to 83). Retrospective chart review was performed. Relevant factors for recurrence as well as survival and progression-free interval were analyzed.

The median follow-up interval from the initial operation was 83 months (range, 9 to 515). Recurrence adversely affected overall survival in surgically resected thymic tumors (p = 0.0014). In multivariate analysis, the initial Masaoka stage, incomplete resection, and World Health Organization histology were significant risk factors for recurrence. In multivariate analysis, only surgical management was associated with prolonged survival p = 0.0038) and improved progression-free interval (p = 0.0378) in recurrent thymoma. Five-year survival after recurrent thymoma was 54%. For recurrent thymic carcinoma, surgery did not improve survival. For these patients, chemotherapy was associated with improved progression-free interval after recurrence (p = 0.0295). There were no 5-year survivors of recurrent thymic carcinoma.

Our data suggest that surgical management is associated with better outcome and is the treatment of choice for recurrent thymoma. For recurrent thymic carcinoma, surgical management has a very limited role, and chemotherapy appears to be a more effective treatment modality.