Surgical therapy of malignant thymoma.

OBJECTIVE

To give a modern concept for treating tumours of the thymic gland.

EXPERIMENTAL DESIGN

Retrospective analysis of all patients treated for thymic disease in the last 6 years with a mean follow-up of 22.3 months (range: 3-71 months).

SETTING

All patients were admitted to the Department of Surgery of the University of Cologne with an average hospitalisation period of 14 days. Patients with myasthenia gravis were transferred to the intensive care unit postoperatively.

PATIENTS

A total of 34 patients were treated by radical thymectomy. All patients had a routine chest roentgenogram and a computed tomography. In 13 patients a malignant tumour of the thymic gland was diagnosed. In 6 patients the main symptom was myasthenia gravis.

INTERVENTIONS

All tumours were successfully resected by an upper median sternotomy which was extended through a Kocher incision (n = 2) or a complete sternotomy (n = 3). In one patient the tumour was unresectable.

RESULTS

In four patients histological examination showed a thymic carcinoma and in 9 patients an invasive thymoma. Four patients died during follow-up period. Stage II to IV thymoma should receive postoperative radiotherapy and an additionally chemotherapy in stage IV. Cumulative survival rate for a five years follow-up independent of the tumour stage was 46%.

CONCLUSIONS

Malignant tumours of the thymic gland are a rare entity and should be treated by radical resection of the tumour and the adjacent tissue. In stage II and III postoperative radiation can lower the risk of recurrence. In stage IV radiation should combined with chemotherapy. Long-term follow-up is mandatory.