Minimal Access Surgery for Thymoma
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Minimal Access Surgery for Thymoma Arvind Kumar 1 & Belal Bin Asaf 2 & Mohan Venkatesh Pulle 2 & Harsh Vardhan Puri 2 & Sukhram Bishnoi 2 & Srinivas Kodaganur Gopinath 3 Received: 30 March 2020 / Accepted: 24 August 2020 # Indian Association of Surgical Oncology 2020
Abstract Thymoma is a rare epithelial tumor of the thymus gland. Despite rarity, it is the most common tumor of the anterior mediastinum. Surgical resection in the form of extended thymectomy is the gold standard operation. Conventionally and even in the current era of significant advances in the minimally invasive surgery, open transsternal extended thymectomy is considered the gold standard, particularly for advanced-stage tumors. There is however significant evidence now available for the use of minimally invasive approaches for early-stage thymomas. This article aims to discuss the various minimally invasive approaches currently being employed for thymomas. Keywords Thymoma . Thoracoscopic Thymectomy . VATS Thymectomy . Thymectomy . Myasthenia Gravis
Introduction Thymoma is a malignant tumor that arises from thymic epithelial cells. Although it is the commonest tumor of the anterior mediastinum [1], evidence-based management guidelines are lacking due to its rarity. Surgery is the mainstay of treatment, with extended thymectomy being the gold standard [2]. When complete surgical resection is in doubt, induction chemotherapy followed by surgery, with or without postoperative radiotherapy, is recommended [3, 4]. Conventionally, thymectomy has been performed by transsternal approach which gives excellent exposure from the neck to the diaphragm along with access to bilateral pleural cavities. It is still considered the gold standard approach
* Arvind Kumar [email protected] Belal Bin Asaf [email protected] 1
Department of Thoracic Surgery and Institute of Robotic Surgery, Sir Ganga Ram Hospital, New Delhi, India
2
Department of Thoracic Surgery & Institute of Robotic Surgery, Sir Ganga Ram Hospital, New Delhi, India
3
DNB Thoracic Surgery, Department of Thoracic Surgery and Director, Institute of Robotic Surgery, Sir Ganga Ram Hospital, New Delhi, India
[5], particularly for advanced-stage tumors. However, sternotomy does inflict lot of “trauma of access” on the body, with its attendant complications [6]. In the last 30 years, evidence has accumulated in the literature about minimal access surgery (MAS) for resection of thymomas and their pros and cons. This article presents an overview of the current status of MAS for thymoma. Before we discuss the MAS techniques for thymoma resection, it is important to highlight three key issues which have bearing on the surgical and survival outcome of thymoma and need to be strictly adhered to while performing MAS for thymoma. These are (1) extent of resection, (2) tumor handling, and (3) pre-operative optimization of myasthenia gravis (if patient is myasthenic). We have witnessed, with pain and anguish, an attempt by surgeons sometimes to neglect these key issues due to the limitati
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