Advanced thymic epithelial tumour resection: vascular resection and reconstruction strategy

Area of Science:

• Thoracic surgery
• Surgical oncology
• Vascular reconstruction

Background:

• Thymic epithelial tumors (TETs) are primary anterior mediastinal malignancies.
• Advanced TETs often necessitate complex surgical interventions, including major vascular resections.
• Complete resection (R0) is crucial for favorable prognosis in advanced TETs.

Purpose of the Study:

• To analyze the outcomes of advanced thymic epithelial tumor resections involving vascular reconstruction.
• To evaluate the feasibility and safety of extensive surgical procedures for advanced TETs.

Main Methods:

• Retrospective analysis of 14 patients with advanced stage III/IV TET undergoing vascular resection and reconstruction.
• Preoperative evaluation included CT, PET, biopsy, and exercise testing.
• Surgical approach involved resection of superior vena cava (SVC) and innominate veins with polytetrafluoroethylene (PTFE) graft reconstruction.

Main Results:

• A total of 31 patients underwent surgery for advanced TET, with 14 requiring major vessel reconstruction.
• Achieved an R0 resection rate of 78.6% with a recurrence rate of 14.3% at median follow-up of 1,700 days.
• Postoperative complications occurred in 42.9% of patients, with an in-hospital mortality rate of 7.1%.

Conclusions:

• Multi-disciplinary management, meticulous preoperative planning, and advanced surgical techniques are vital for treating advanced TET.
• Complex vascular resections for advanced TET should be performed in high-volume centers to optimize patient outcomes.