Kazuo Nakagawa1, Kohei Yokoi2, Jun Nakajima3, Fumihiro Tanaka4, Yoshimasa Maniwa5, Makoto Suzuki6, Takeshi Nagayasu7, Hisao Asamura8. 1. Department of Thoracic Surgery, National Cancer Center Hospital, Tokyo, Japan. Electronic address: kznakaga@ncc.go.jp. 2. Department of Thoracic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan. 3. Department of Thoracic Surgery, Graduate School of Medicine, University of Tokyo, Tokyo, Japan. 4. Second Department of Surgery, University of Occupational and Environmental Health, Kitakyushu, Japan. 5. Division of Thoracic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan. 6. Department of Thoracic Surgery, Kumamoto University Graduate School of Medical Sciences, Kumamoto, Japan. 7. Department of Surgical Oncology, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan. 8. Department of Thoracic Surgery, National Cancer Center Hospital, Tokyo, Japan.
Abstract
BACKGROUND: The optimal mode of resection for thymoma in nonmyasthenic patients remains unclear. The aim of this study was to explore whether or not thymomectomy alone is a relevant option for patients with stage I (T1N0M0) thymoma in the proposed TNM classification. METHODS: We investigated 2,835 patients with thymic epithelial tumors treated at 32 institutions participating in the Japanese Association for Research on the Thymus (JART). A total of 1286 patients with thymomectomy: resection of thymoma with partial thymectomy (n = 289) or thymothymomectomy: resection of thymoma with total thymectomy (n = 997) for stage I thymoma were included. Surgical and oncologic outcomes were compared between the 2 groups. RESULTS: Patients who underwent thymomectomy were older (61.1 versus 57.0 years; p = 0.000) and had smaller tumors (4.77 versus 5.99 cm; p = 0.000) than those who underwent thymothymomectomy. There was a significant difference in the distribution of histologic subtype (p = 0.007). After propensity-score matching, the matched cohort consisted of 276 patients in each group. Postoperative complications were seen more frequently in the thymothymomectomy group than in the thymomectomy group (8.3% versus 4.3%; p = 0.0397). The 5-year overall survival rate was 97.3% in the thymomectomy group and 96.9% in the thymothymomectomy group (p = 0.487). Patients who underwent thymomectomy tended to have local recurrence more frequently than did those who underwent thymothymomectomy (2.2% versus 0.4%; p = 0.0613). CONCLUSIONS: Thymomectomy alone is acceptable for stage I thymoma in regard to postoperative complications and prognosis. Further studies are needed to evaluate long-term outcomes.
BACKGROUND: The optimal mode of resection for thymoma in nonmyasthenic patients remains unclear. The aim of this study was to explore whether or not thymomectomy alone is a relevant option for patients with stage I (T1N0M0) thymoma in the proposed TNM classification. METHODS: We investigated 2,835 patients with thymic epithelial tumors treated at 32 institutions participating in the Japanese Association for Research on the Thymus (JART). A total of 1286 patients with thymomectomy: resection of thymoma with partial thymectomy (n = 289) or thymothymomectomy: resection of thymoma with total thymectomy (n = 997) for stage I thymoma were included. Surgical and oncologic outcomes were compared between the 2 groups. RESULTS:Patients who underwent thymomectomy were older (61.1 versus 57.0 years; p = 0.000) and had smaller tumors (4.77 versus 5.99 cm; p = 0.000) than those who underwent thymothymomectomy. There was a significant difference in the distribution of histologic subtype (p = 0.007). After propensity-score matching, the matched cohort consisted of 276 patients in each group. Postoperative complications were seen more frequently in the thymothymomectomy group than in the thymomectomy group (8.3% versus 4.3%; p = 0.0397). The 5-year overall survival rate was 97.3% in the thymomectomy group and 96.9% in the thymothymomectomy group (p = 0.487). Patients who underwent thymomectomy tended to have local recurrence more frequently than did those who underwent thymothymomectomy (2.2% versus 0.4%; p = 0.0613). CONCLUSIONS: Thymomectomy alone is acceptable for stage I thymoma in regard to postoperative complications and prognosis. Further studies are needed to evaluate long-term outcomes.
Authors: Wentao Fang; Xiaopan Yao; Alberto Antonicelli; Zhitao Gu; Frank Detterbeck; Eric Vallières; Ralph W Aye; Alexander S Farivar; James Huang; Yue Shang; Brian E Louie Journal: Eur J Cardiothorac Surg Date: 2017-07-01 Impact factor: 4.191