Robotic Resection With Hyperthermic Intrathoracic Perfusion Chemotherapy for Thymoma Recurrence

Thymoma recurrence with pleural dissemination remains a therapeutic challenge, often requiring multimodal treatment strategies. Cytoreductive surgery combined with hyperthermic intrathoracic chemotherapy (HITHOC) has emerged as a promising approach for selected patients; however, reports using minimally invasive robotic platforms are limited. We present the case of a 41-year-old woman with pleural and lymph node recurrence of type AB thymoma 3 years after robotic extended thymectomy. The patient underwent robotic-assisted cytoreductive surgery, including complete parietal pleurectomy and resection of pleural, pericardial, and subaortic lymph node lesions, followed by HITHOC with cisplatin and doxorubicin. The procedure was performed safely, with no major perioperative complications. The patient was discharged after 7 days and remained disease-free at 2-year follow-up. This case highlights the feasibility, safety, and potential oncological benefits of combining robotic cytoreductive surgery with HITHOC in the management of recurrent thymoma with pleural involvement. This minimally invasive multimodal strategy may represent a valuable option for carefully selected patients, although further studies with larger cohorts and longer follow-up are warranted.