Thymectomy and transpericardial nodal dissection

Neuroendocrine thymic tumors (NETTs) are rare neoplasms. Surgical resection of the tumor and the involved lymph node remains the treatment of choice. We describe the surgical technique adopted in a patient with preoperative diagnosis of thymic malignant tumor and subcarinal nodal involvement. Through a median sternotomy, an extended thymectomy was performed as a first step. Then, through the transpericardial approach (opening of the anterior and posterior pericardium and isolation of ascending aorta, superior vena cava, and main right pulmonary artery), mediastinal nodal dissection (#2R, #4R, #4L, #5 and #7) was performed. Definitive pathology showed a NETT without nodal involvement. The patient received adjuvant chemotherapy, and is alive without disease 19 months after the surgery. Complete surgical excision and adjuvant therapy appears to offer the best hope for prolonged survival for NETTs. The surgical technique should be individualized according to tumor location. Thoracic surgeons should be familiar with this technique, which provides a good technical and oncological result.