Is it valuable and safe to perform reoperation for recurrent thymoma?

A best evidence topic in thoracic surgery was written according to a structured protocol. The question addressed was whether it is valuable and safe to perform reoperation for recurrent thymoma. Altogether, more than 500 papers were found using the reported search, of which 15 represented the best evidence to answer the clinical question. The authors, journal, date and country of publication, patient group studied, study type, relevant outcomes and results of these papers are tabulated. This paper includes 1 level 1a study and 15 level 2b studies. The operative mortality was reported in six studies, ranging from 0 to 13.3%, and the operative morbidity in five studies, ranging from 0 to 32.1%. Most patients suffering from operative mortality (5/5) and morbidity (16/19) had myasthenia gravis. One meta-analysis demonstrated improved rates of long-term overall survival in patients with recurrent thymoma who were treated surgically compared with those treated non-surgically. Ten studies showed better survival after surgical treatment than after non-surgical treatment with the difference being statistically significant in 4 of them. Two studies reported that the prognosis in patients with complete reresection was comparable with that of patients without recurrence. One study found that patients with a thymus-related syndrome improved after re-resection. Another two studies revealed that debulking surgery for recurrent thymoma was associated with poorer survival and worse outcomes than both complete resection and non-surgical therapy. From the papers identified in our search, we can conclude that reoperation can be performed with acceptable morbidity and low mortality in appropriately selected patients with locally and/or regionally recurrent thymoma. Both survival and thymus-related syndromes are improved if the recurrence is surgically resected when compared with other medical treatments. Debulking surgery should be limited to those few selected patients in whom other treatment options are not available. In addition, morbidity and mortality most commonly occur in association with myasthenia gravis, and hence medical control of this should be optimized prior to reoperation.