Chandarana Karishma, Koulouroudias Marinos, Weaver Helen, Nakas Apostolos
Department of Thoracic Surgery, Glenfield Hospital, University Hospitals of Leicester Trust, Leicester, United Kingdom.
JTCVS Open. 2025 Apr 24;26:279-287. doi: 10.1016/j.xjon.2025.04.010. eCollection 2025 Aug.
The European Society of Medical Oncology supports the use of surgery with adjuvant radiotherapy in resectable Masaoka-Koga Stage IV thymomas. We explore the role of extended pleurectomy decortication (EPD) and extrapleural pneumonectomy (EPP) in the management of patients with Masaoka-Koga stage IV thymic tumors with pleural involvement from our single-center experience.
We conducted a retrospective analysis of patients who had undergone extended resections over a 10-year period for Masaoka-Koga stage IV thymomas at our thoracic unit in the United Kingdom. Data was gathered from patient records and electronic databases.
Ten patients were included in our series; 90% with primary thymoma and 10% with metastatic recurrence. In total, 80% of patients had EPD and 20% EPP; 60% had pericardium resected and 50% the ipsilateral hemidiaphragm. Length of stay was 2 to 21 days (median, 7 days). There was no in-hospital or 90-day mortality. Histology subtypes were variable: World Health Organization type AB (20%), B1 (10%), B2 (50%), and B3 (20%). A total of 60% of patients had R1 resection. All patients had adjuvant therapy. In total, 70% of patients had disease recurrence with an average disease-free interval of 44 months (range, 8 months to 10 years). Five-year survival was 90% with an overall survival of 60%.
This series supports the use of extended resections in selected patients with Masaoka-Koga stage IV thymoma as part of multimodality treatment. EPP and EPD are not part of routine thoracic surgery practice in the United Kingdom. We suggest these cases are referred to dedicated centers with required expertise.
欧洲医学肿瘤学会支持对可切除的Masaoka-Koga IV期胸腺瘤采用手术联合辅助放疗。我们根据单中心经验，探讨扩大胸膜剥脱术（EPD）和胸膜外全肺切除术（EPP）在治疗伴有胸膜受累的Masaoka-Koga IV期胸腺肿瘤患者中的作用。
我们对在英国胸外科接受了为期10年的Masaoka-Koga IV期胸腺瘤扩大切除术的患者进行了回顾性分析。数据收集自患者记录和电子数据库。
我们的系列研究纳入了10例患者；90%为原发性胸腺瘤，10%为转移性复发。总体而言，80%的患者接受了EPD，20%接受了EPP；60%的患者切除了心包，50%切除了同侧半膈肌。住院时间为2至21天（中位数为7天）。无院内死亡或90天内死亡。组织学亚型多样：世界卫生组织AB型（20%）、B1型（10%）、B2型（50%）和B3型（20%）。共有60%的患者为R1切除。所有患者均接受了辅助治疗。总体而言，70%的患者出现疾病复发，平均无病生存期为44个月（范围为8个月至10年）。5年生存率为90%，总生存率为60%。
本系列研究支持在选定的Masaoka-Koga IV期胸腺瘤患者中采用扩大切除术作为多模式治疗的一部分。EPP和EPD并非英国胸外科常规手术操作的一部分。我们建议将这些病例转诊至具备所需专业知识的专门中心。
