Alfonso Fiorelli1, Antonio D'Andrilli2, Camilla Vanni3, Roberto Cascone4, Marco Anile2, Daniele Diso2, Valentina Tassi5, Jacopo Vannucci6, Nicola Serra7, Francesco Puma6, Erino Angelo Rendina3, Federico Venuta2, Mario Santini4. 1. Thoracic Surgery Unit, Second University of Naples, Naples, Italy. Electronic address: alfonso.fiorelli@unina2.it. 2. Thoracic Surgery Unit, University of Rome Sapienza, Rome, Italy. 3. Thoracic Surgery Unit, Sant'Andrea Hospital, University of Rome Sapienza, Rome, Italy. 4. Thoracic Surgery Unit, Second University of Naples, Naples, Italy. 5. Thoracic Surgery Unit, University of Perugia, Perugia, Italy; Alma Mater Studiorum, University of Bologna, Bologna, Italy. 6. Thoracic Surgery Unit, University of Perugia, Perugia, Italy. 7. Department of Radiology, Second University of Naples, Naples, Italy.
Abstract
BACKGROUND: In this study, we evaluated if surgical treatment and iterative operations could confer a survival advantage for patients with recurrent or repeated recurrences of thymoma. METHODS: Between 1984 and 2014, 53 of 515 (10%) patients had recurrences after complete thymoma resection. Demographics, stage, treatment, and pathologic findings were statistically analyzed to identify survival prognostic factors. RESULTS: Thirty-eight of 53 (72%) patients underwent resection of recurrent thymoma; 32 (84%) underwent complete resection. Fifteen (28%) patients did not undergo resection; 3 (20%) received chemotherapy alone, 10 (67%) received chemoradiotherapy, and 2 (13%) received supportive care. At univariate analysis, World Health Organization (WHO) AB + B1 histologic types (p < 0.0001), R0 resection (p < 0.0001), myasthenia gravis (MG) (p = 0.02), and adjuvant therapy after recurrence (p = 0.03) were significant prognostic factors. At multivariate analysis, complete resection (p = 0.0003) was the only significant prognostic factor. Among patients with repeated resections, those undergoing complete resection had better survival than did those undergoing incomplete resection or no operative procedure (p = 0.02). Seven patients are alive and free of disease, with a median survival of 115 months (70-161 months) and 149 months (61-201 months) from the first recurrence and from thymoma resection, respectively. CONCLUSIONS: Complete resection is a viable treatment option for selected patients with recurrent thymomas. In cases of technically resectable repeated recurrences, repeated operations should be considered.
BACKGROUND: In this study, we evaluated if surgical treatment and iterative operations could confer a survival advantage for patients with recurrent or repeated recurrences of thymoma. METHODS: Between 1984 and 2014, 53 of 515 (10%) patients had recurrences after complete thymoma resection. Demographics, stage, treatment, and pathologic findings were statistically analyzed to identify survival prognostic factors. RESULTS: Thirty-eight of 53 (72%) patients underwent resection of recurrent thymoma; 32 (84%) underwent complete resection. Fifteen (28%) patients did not undergo resection; 3 (20%) received chemotherapy alone, 10 (67%) received chemoradiotherapy, and 2 (13%) received supportive care. At univariate analysis, World Health Organization (WHO) AB + B1 histologic types (p < 0.0001), R0 resection (p < 0.0001), myasthenia gravis (MG) (p = 0.02), and adjuvant therapy after recurrence (p = 0.03) were significant prognostic factors. At multivariate analysis, complete resection (p = 0.0003) was the only significant prognostic factor. Among patients with repeated resections, those undergoing complete resection had better survival than did those undergoing incomplete resection or no operative procedure (p = 0.02). Seven patients are alive and free of disease, with a median survival of 115 months (70-161 months) and 149 months (61-201 months) from the first recurrence and from thymoma resection, respectively. CONCLUSIONS: Complete resection is a viable treatment option for selected patients with recurrent thymomas. In cases of technically resectable repeated recurrences, repeated operations should be considered.
Authors: Christian Galata; Stefan Porubsky; Daniel Sebastian Dohle; Ioannis Karampinis; Davor Stamenovic; Eric Dominic Roessner Journal: Mediastinum Date: 2022-03-25