Aprile Vittorio, Bacchin Diana, Korasidis Stylianos, Nesti Agnese, Marrama Elena, Ricciardi Roberta, Petrini Iacopo, Ambrogi Marcello Carlo, Paladini Piero, Lucchi Marco
Division of Thoracic Surgery, Cardiac-Thoracic and Vascular Department, University Hospital of Pisa, Pisa, Italy.
Department of Clinical and Experimental Medicine, Neurology Unit, University Hospital of Pisa, Pisa, Italy.
Interact Cardiovasc Thorac Surg. 2020 May 1;30(5):765-772. doi: 10.1093/icvts/ivaa019.
Recurrence of thymoma is described in 10-30% of cases after surgical resection. Iterative surgery for thymoma pleural relapses (TPRs) is often part of a multimodal treatment. Hyperthermic intrathoracic chemotherapy (HITHOC) following macroscopic radical surgery is an option that combines the effects of mild hyperthermia with those of chemotherapeutic agents. We evaluated the effectiveness of surgery + HITHOC, compared with surgery alone, in the treatment of TPR.
We retrospectively collected data of all patients who underwent surgery for TPR in our centre from 2005 to 2017. Relapses were treated by partial pleurectomy with radical intent, followed by HITHOC when not contraindicated. Patients were divided into 2 groups: surgery + HITHOC and surgery alone. We collected demographic and clinical data and analysed postoperative results together with oncological outcomes.
Forty patients (27: surgery + HITHOC, 13: surgery alone), mean age 49.8 (±13.7) years, were included in this study. There were no perioperative deaths. We experienced 33.3% perioperative morbidity in the surgery + HITHOC group compared with 23.1% in the surgery alone group (P = 0.71). The overall survival rate was comparable between the 2 groups (P = 0.139), whereas the local disease-free interval was 88.0 ± 15 months in the surgery + HITHOC group and 57 ± 19.5 months in the surgery alone group (P = 0.046). The analysis of factors affecting the outcomes revealed that radical surgery is related with a better survival rate whereas the local disease-free interval was significantly influenced by HITHOC.
The safety and feasibility of HITHOC in the treatment of TPR are already known, even if it should be reserved for selected patients. Surgery + HITHOC seems to be associated with a longer local disease-free time compared to surgery alone.
胸腺瘤手术切除后10%-30%的病例会出现复发。胸腺瘤胸膜复发（TPR）的反复手术通常是多模式治疗的一部分。宏观根治性手术后的胸腔内热化疗（HITHOC）是一种将温和热疗与化疗药物的作用相结合的选择。我们评估了手术+HITHOC与单纯手术相比在治疗TPR中的有效性。
我们回顾性收集了2005年至2017年在我们中心接受TPR手术的所有患者的数据。复发采用根治性部分胸膜切除术治疗，在无禁忌证时随后进行HITHOC。患者分为两组：手术+HITHOC组和单纯手术组。我们收集了人口统计学和临床数据，并分析了术后结果以及肿瘤学结局。
本研究纳入了40例患者（27例：手术+HITHOC组，13例：单纯手术组），平均年龄49.8（±13.7）岁。无围手术期死亡。手术+HITHOC组围手术期发病率为33.3%，而单纯手术组为23.1%（P = 0.71）。两组的总生存率相当（P = 0.139），而手术+HITHOC组的局部无病生存期为88.0±15个月，单纯手术组为57±19.5个月（P = 0.046）。影响结局的因素分析显示，根治性手术与更好的生存率相关，而局部无病生存期受HITHOC的显著影响。
HITHOC治疗TPR的安全性和可行性已经明确，即使应仅用于选定的患者。与单纯手术相比，手术+HITHOC似乎与更长时间的局部无病期相关。
