Minimally Invasive Total Versus Partial Thymectomy for Early-Stage Thymoma

Area of Science:

• Thoracic surgery
• Surgical oncology
• Immunology

Background:

• Total thymectomy is standard for thymoma, but thymus removal may have long-term health risks, including autoimmune diseases and increased mortality.
• The potential consequences of thymus removal necessitate evaluating alternative surgical approaches for thymoma treatment.

Purpose of the Study:

• To compare oncologic outcomes between total thymectomy and partial thymectomy for early-stage thymoma.
• To assess short-term and long-term survival differences between partial and total thymectomy in early-stage thymoma patients.

Main Methods:

• Retrospective analysis of 1598 patients with WHO types A-B3 thymoma (2010-2021), excluding advanced stages and neoadjuvant therapy.
• Patients were stratified into partial and total thymectomy groups; propensity score matching was used to control for confounding factors.
• Kaplan-Meier survival analysis and Cox proportional hazards models were employed to evaluate oncologic outcomes and survival.

Main Results:

• Partial thymectomy (31.0%) and total thymectomy (69.0%) groups showed no significant differences in baseline characteristics.
• Short-term mortality (30- and 90-day) and long-term (10-year) survival rates were similar between the two surgical approaches, even after matching.
• Partial thymectomy was not independently associated with adverse survival outcomes (aHR = 1.00, p = 0.976).

Conclusions:

• Partial thymectomy is a viable alternative to total thymectomy for early-stage thymoma, demonstrating comparable short- and long-term oncologic outcomes.
• These findings support the consideration of partial thymectomy to potentially mitigate the long-term health consequences associated with complete thymus removal.
• The results provide crucial data for shared decision-making discussions between clinicians and patients regarding thymus preservation in early-stage thymoma management.