Odaka Makoto, Akiba Tadashi, Mori Shohei, Asano Hisatoshi, Marushima Hideki, Yamashita Makoto, Kamiya Noriki, Morikawa Toshiaki
Department of Surgery, Jikei University School of Medicine, Minatoku, Tokyo, Japan.
Interact Cardiovasc Thorac Surg. 2013 Aug;17(2):285-90. doi: 10.1093/icvts/ivt182. Epub 2013 Apr 30.
Thoracoscopic thymectomy has gradually replaced conventional sternotomy for resection of thymoma; however, a thoracoscopic approach for thymoma remains controversial. We evaluated the oncological outcomes of thoracoscopic thymectomy for the treatment of stages I-III thymomas.
Sixty-two patients who underwent thoracoscopic thymectomy for the treatment of thymoma were retrospectively reviewed between July 2005 and September 2011 at Jikei University Hospital. Surgical outcomes and pathological results between stages I+II and stage III were compared.
Twenty-nine patients had Masaoka stage I, 28 had stage II and 5 had stage III. Three stage III patients needed conversions to open surgery. Masaoka stage III comprised pathological type B3 in 3 patients and thymic carcinoma in 2. For all patients, the 5-year overall survival rate was 100%. Three recurrences, diagnosed as thymic carcinoma, were observed in the Masaoka stage II or III patients. The 5-year disease-free survival rate was 94.2% for all patients, 100% for Masaoka stage I, 96.1% for stage II and 37.5% (55 months) for stage III (P=0.002). The 5-year disease-free survival rate was 100% for the World Health Organization classification types A, AB and B1-3 and 0% for thymic carcinoma (P<0.0001). Significant differences were found in the 5-year disease-free survival stratified by the Masaoka stage or WHO classification, but not by surgical procedures.
Thoracoscopic thymectomy for Masaoka stages I and II thymomas presented acceptable oncological outcomes. Further investigation in a large series with longer follow-up is required. Masaoka stage III thymoma requires careful consideration of the approaches, including median sternotomy.
胸腔镜下胸腺切除术已逐渐取代传统胸骨切开术用于胸腺瘤切除；然而，胸腔镜治疗胸腺瘤的方法仍存在争议。我们评估了胸腔镜下胸腺切除术治疗Ⅰ-Ⅲ期胸腺瘤的肿瘤学结局。
回顾性分析2005年7月至2011年9月在日本庆应义塾大学医院接受胸腔镜下胸腺切除术治疗胸腺瘤的62例患者。比较Ⅰ+Ⅱ期和Ⅲ期患者的手术结局及病理结果。
29例患者为Masaoka Ⅰ期，28例为Ⅱ期，5例为Ⅲ期。3例Ⅲ期患者需要转为开放手术。Masaoka Ⅲ期患者中，3例为病理类型B3，2例为胸腺癌。所有患者的5年总生存率为100%。在Masaoka Ⅱ期或Ⅲ期患者中观察到3例复发，诊断为胸腺癌。所有患者的5年无病生存率为94.2%，Masaoka Ⅰ期为100%，Ⅱ期为96.1%，Ⅲ期为37.5%（55个月）（P=0.002）。世界卫生组织分类的A、AB和B1-3型5年无病生存率为100%，胸腺癌为0%（P<0.0001）。按Masaoka分期或世界卫生组织分类分层的5年无病生存率存在显著差异，但按手术方式分层则无差异。
胸腔镜下胸腺切除术治疗Masaoka Ⅰ期和Ⅱ期胸腺瘤的肿瘤学结局可接受。需要对大量患者进行更长时间随访的进一步研究。Masaoka Ⅲ期胸腺瘤需要仔细考虑手术方式，包括正中胸骨切开术。
