Belcher Elizabeth, Hardwick Timothy, Lal Rohit, Marshall Stuart, Spicer James, Lang-Lazdunski Loic
Department of Thoracic Surgery, Guy's Hospital, Great Maze Pond, London SE1 9RT, UK.
Interact Cardiovasc Thorac Surg. 2011 May;12(5):744-7. doi: 10.1510/icvts.2010.255307. Epub 2010 Dec 20.
The optimal treatment for Masaoka stage IVA thymoma remains controversial. Whilst extrapleural pneumonectomy (EPP) has been proposed, we sought to examine the results of our institutional preference for induction chemotherapy, cytoreductive surgery and intraoperative hyperthermic pleural irrigation. We undertook a retrospective study of patients undergoing surgery for Masaoka stage IVA thymoma following induction chemotherapy over a three-year period at our institution. Between February 2007 and February 2010, 42 patients underwent surgery for thymoma. Six patients underwent surgery with intent to perform cytoreductive surgery and intraoperative hyperthermic pleural irrigation. Complete cytoreductive surgery was not feasible in one patient and thymectomy only was performed. One patient had re-operation for recurrent disease 24 months after the first operation and there were therefore seven procedures undertaken in six patients during the study period. There were no in-hospital deaths. Median follow-up was 18.8 months (range 1.5-31.9 months). One patient died 14 months postoperatively from an acute cardiovascular event. The four remaining patients are alive and well with no evidence of disease recurrence. Multimodality therapy consisting of induction chemotherapy and cytoreductive surgery is a safe, feasible treatment for stage IVA thymoma. Our experience suggest that full pleurectomy is an alternative to EPP.
对于Masaoka IVA期胸腺瘤的最佳治疗方案仍存在争议。虽然有人提出了胸膜外全肺切除术（EPP），但我们试图研究我院倾向采用的诱导化疗、减瘤手术及术中热灌注胸膜固定术的治疗效果。我们对我院在三年期间接受诱导化疗后进行Masaoka IVA期胸腺瘤手术的患者进行了一项回顾性研究。2007年2月至2010年2月期间，42例患者接受了胸腺瘤手术。6例患者接受了减瘤手术及术中热灌注胸膜固定术。1例患者无法进行完全减瘤手术，仅实施了胸腺切除术。1例患者在首次手术后24个月因疾病复发接受了再次手术，因此在研究期间6例患者共进行了7次手术。无住院死亡病例。中位随访时间为18.8个月（范围1.5 - 31.9个月）。1例患者术后14个月死于急性心血管事件。其余4例患者存活且状况良好，无疾病复发迹象。由诱导化疗和减瘤手术组成的多模式治疗对于IVA期胸腺瘤是一种安全、可行的治疗方法。我们的经验表明，全胸膜切除术是EPP的一种替代方案。
