Refaely Y, Simansky D A, Paley M, Gottfried M, Yellin A
Department of Thoracic Surgery, Sheba Medical Center, Tel Hashomer, Israel.
Ann Thorac Surg. 2001 Aug;72(2):366-70. doi: 10.1016/s0003-4975(01)02786-2.
Thymoma and thymic carcinoma with pleural spread have a high rate of locoregional recurrence and poor prognosis. Maximal debulking coupled with aggressive local treatment could offer a chance for cure. This study evaluates the early and midterm results of operation and hyperthermic pleural perfusion with cisplatinum for thymic malignancies.
Fifteen patients (11 men), 20 to 67 years old (10 thymoma, 4 thymic carcinoma, 1 carcinoma in thymic cyst) underwent resection and hyperthermic pleural perfusion between 1995 to 2000. All had pleural spread proven before or intraoperatively. Six of the thymoma cases were recurrent. Current operation included resection without pleurectomy (9 patients), resection with pleurectomy (5), and extrapleural pneumonectomy (1 patient) with intraoperative hyperthermic pleural perfusion in all. Intrapleural temperature reached 40.3 degrees C to 43 degrees C. The total dose of cisplatinum was 150 mg or more in 14 patients.
Complete resection (R0) was achieved in 10 patients, subtotal (R1) in 3, and partial (R2) in 2. There was no operative mortality, no hemodynamic or respiratory disturbances during perfusion, and no hematologic, neurologic, or renal complications. Complications consisted of significant bleeding (2 patients), fever (2), and air leak (1 patient). Two patients with thymic carcinoma died after 27 and 34 months, and 1 is alive with no evidence of disease at 54 months. Two patients with thymoma died after 7 and 36 months. Eight are alive after 9 to 70 months. Four patients (all R0) are alive without local recurrence more than 60 months after operation and hyperthermic pleural perfusion.
Operation and thermochemotherpy is feasible and safe in patients with thymic tumors. This method seems to offer excellent local control for patients with stage IV-a thymic malignancies. Midterm results suggest that operation plus hyperthermic pleural perfusion may lengthen survival in stage IV-a thymoma.
伴有胸膜播散的胸腺瘤和胸腺癌局部区域复发率高，预后差。最大限度地减瘤并联合积极的局部治疗可能带来治愈机会。本研究评估了手术及顺铂热灌注治疗胸腺恶性肿瘤的早期和中期结果。
1995年至2000年间，15例患者（11例男性），年龄20至67岁（10例胸腺瘤，4例胸腺癌，1例胸腺囊肿内癌）接受了手术切除及热灌注治疗。所有患者术前或术中均证实有胸膜播散。其中6例胸腺瘤患者为复发病例。当前手术包括未行胸膜切除术的切除（9例患者）、行胸膜切除术的切除（5例）和胸膜外全肺切除术（1例患者），所有患者术中均进行了热灌注。胸腔内温度达到40.3℃至43℃。14例患者顺铂总剂量为150mg或更多。
10例患者实现了根治性切除（R0），3例为次全切除（R1），2例为部分切除（R2）。无手术死亡，灌注期间无血流动力学或呼吸紊乱，无血液学、神经学或肾脏并发症。并发症包括严重出血（2例患者）、发热（2例）和气漏（1例患者）。2例胸腺癌患者分别在27个月和34个月后死亡，1例在54个月时存活且无疾病证据。2例胸腺瘤患者分别在7个月和36个月后死亡。8例在9至70个月后存活。4例患者（均为R0）在手术及热灌注治疗后60多个月存活且无局部复发。
手术及热化疗对胸腺肿瘤患者是可行且安全的。该方法似乎能为IV-a期胸腺恶性肿瘤患者提供良好的局部控制。中期结果表明，手术加胸腔热灌注可能延长IV-a期胸腺瘤患者的生存期。
