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Nerve-Sparing Surgery in Advanced Stage Thymomas.

Vittorio Aprile1, Pietro Bertoglio2, Stylianos Korasidis1

  • 1Division of Thoracic Surgery, Cardiac, Thoracic, and Vascular Department, University of Pisa, Pisa, Italy.

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Nerve-sparing surgery for invasive thymoma is feasible, preserving diaphragmatic function in many patients. This approach, combined with radiotherapy, offers acceptable disease control and survival outcomes.

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Area of Science:

  • Thoracic Surgery
  • Surgical Oncology
  • Neurosurgery

Background:

  • Advanced thymomas frequently involve the phrenic nerve (up to 33%).
  • Standard en bloc resection can lead to diaphragmatic dysfunction and impaired pulmonary function.

Purpose of the Study:

  • To evaluate the outcomes of nerve-sparing resection for invasive thymoma.
  • To assess the feasibility and efficacy of preserving phrenic nerve function during thymoma surgery.

Main Methods:

  • Retrospective analysis of patients with advanced thymoma and macroscopic phrenic nerve involvement undergoing nerve-sparing resection (1990-2015).
  • All patients received adjuvant radiotherapy (45-60 Gy) +/- chemotherapy.
  • Long-term outcomes and recurrence patterns were analyzed.

Main Results:

  • 37 patients (19 female, 18 male, median age 52) underwent nerve-sparing resection; 25 had associated myasthenia gravis.
  • Postoperative phrenic palsy occurred in 12 patients, with 4 recovering.
  • Recurrence was observed in 10 patients (7 stage IVa, 3 stage III).
  • Overall survival was 265.4 months; disease-free survival was 233.2 months.

Conclusions:

  • Phrenic nerve preservation during invasive thymoma resection is feasible.
  • The technique, combined with radiotherapy, provides acceptable local disease control.
  • This approach may benefit patients with comorbidities or poor performance status.