Department of Thoracic Surgery and Heart-Lung Transplantation, Université Paris-Saclay, Hôpital Marie-Lannelongue, Groupe Hospitalier Paris Saint Joseph, Le Plessis Robinson, France.
Department of Thoracic Surgery and Heart-Lung Transplantation, Université Paris-Saclay, Hôpital Marie-Lannelongue, Groupe Hospitalier Paris Saint Joseph, Le Plessis Robinson, France.
Respir Med Res. 2023 Jun;83:101009. doi: 10.1016/j.resmer.2023.101009. Epub 2023 Mar 23.
Thymic malignancies are rare tumors about which data are limited. Our objective here was to evaluate the outcomes and risk factors for complications and death in patients who underwent extended surgery to remove thymic malignancies.
We retrospectively included patients who underwent extended resection of locally advanced, nonmetastatic thymic malignancies at our institution. Patients were deemed eligible for resection by a multidisciplinary team. During surgery, priority was given to achieving complete resection rather than to sparing organs.
The 108 patients had a mean age of 53 ± 15 years (range, 9-83); among them, 91 had thymoma, 12 thymic carcinoma, and 5 neuroendocrine tumor. The Masaoka stage was III or higher in 86 patients; examination of operative specimens resulted in downstaging of 22 patients. Tumor-free resection margins were achieved in 98 patients. Overall 5- and 10-year survival rates were 80% and 68%, respectively. Myasthenia gravis, present in 36 patients, was the only independent significant risk factor for major postoperative complications. Age older than 70 years, thymic carcinoma or neuroendocrine tumor, pT3 or pT4 stage, and R1 or R2 resection margins independently predicted death. The number of resected structures was not associated with survival. Thymic carcinoma or neuroendocrine tumor was independently associated with shorter disease-free survival.
In an expert center, extended resection targeting complete resection rather than organ preservation provided good outcomes in patients with locally advanced thymic malignancies. The risk/benefit ratio of surgery should be assessed with special care in patients who are elderly or have myasthenia gravis.
胸腺恶性肿瘤是一种罕见肿瘤，相关数据有限。我们的目的是评估对局部晚期非转移性胸腺恶性肿瘤患者进行扩大手术切除的结局和并发症及死亡风险因素。
我们回顾性纳入了在我院接受局部晚期非转移性胸腺恶性肿瘤扩大切除术的患者。多学科团队认为患者有手术适应证。手术中，优先考虑实现完全切除，而非保留器官。
108 例患者的平均年龄为 53 ± 15 岁（范围 9-83 岁）；其中 91 例为胸腺瘤，12 例为胸腺癌，5 例为神经内分泌肿瘤。86 例患者的 Masaoka 分期为 III 期或更高级别；22 例患者的手术标本检查结果为降期。98 例患者达到肿瘤无残留切缘。总体 5 年和 10 年生存率分别为 80%和 68%。36 例患者存在重症肌无力，是术后发生重大并发症的唯一独立显著风险因素。年龄大于 70 岁、胸腺癌或神经内分泌肿瘤、pT3 或 pT4 期和 R1 或 R2 切缘是独立的死亡预测因素。切除结构的数量与生存无关。胸腺癌或神经内分泌肿瘤与无病生存时间缩短独立相关。
在专家中心，以实现完全切除而非保留器官为目标的扩大切除术为局部晚期胸腺恶性肿瘤患者提供了良好的结局。对于老年或合并重症肌无力的患者，应特别注意手术的风险/获益比。
