Clinical features and outcomes of video-assisted thoracoscopic thymectomies for thymic lymphomas

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BACKGROUND

With small sizes of thymus tumors, modern treatment protocols make it possible to resection them without prior histological verification on the basis of a computed tomography agreement. However, the differential diagnosis of thymomas and thymic lymphomas is extremely difficult. Today there is no clarity about the short-term results and long-term effects of operations in patients with lymphomas in the registry of minimally invasive techniques and video-assisted thoracoscopic thymectomy (VATS TE) in particular.

OBJECTIVE

To improve the results of diagnosis and treatment of thymus tumors by analyzing the diseases of patients with thymic lymphomas and follow-on development of treatment and diagnostic tactics.

MATERIAL AND METHODS

A retrospective analysis of the data of 26 patients with thymus lymphomas (main group), who underwent VATS TE in our center from 2001 to 2020, was carried out. The control group included 53 patients with thymomas who were similarly involved in surgical interference over the same period of time. The medical data, immediate and long-term results were analyzed.

RESULTS

Thymic lymphomas accounted for 8.3% of all solid tumors of the thymus and were associated with myasthenia in 3.8%. These patients had a younger age compared to thymomas — 32.8 and 53.2 (p<0.001), respectively. VATS TE for lymphomas were characterized by a several larger extent of intraoperative blood loss compared to thymomas — 50 ml against 30 ml (p=0.002), but a shorter period of hospitalization — 4.1 and 7.8 days (p<0.001). The median follow-up was 113.5 months. During the entire period of observation, no long-term complications and after-effectiveness of the operation were detected. The adjusted survival rate for patients with thymic lymphomas was 91.1%.

CONCLUSIONS

VATS TE for thymic lymphomas is characterized by a low frequency of postoperative complications and does not adversely affect long-term results, and therefore can be recommended as a therapeutic and diagnostic operation for small encapsulated tumors without prior histological verification of the diagnosis.

Keywords:

video-assisted thoracoscopic surgery

thymectomy

lymphoma

myasthenia

Authors:

Podobed A.V.

Alexandrov National Cancer Center of Belarus

ORCID: 0000-0003-0508-2765

Savchenko O.G.

Alexandrov National Cancer Center of Belarus

ORCID: 0000-0002-5818-8160

Received:

20.01.2024

Accepted:

26.02.2024

List of references:

O’Sullivan KE, Kreaden US, Hebert AE, Eaton D, Redmond KC. A systematic review of robotic versus open and video assisted thoracoscopic surgery (VATS) approaches for thymectomy. Ann Cardiothorac Surg. 2019;8(2):174‐193. https://doi.org/10.21037/acs.2019.02.04
Yang Y, Dong J, Huang Y. Thoracoscopic thymectomy versus open thymectomy for the treatment of thymoma: A meta-analysis. Eur J Surg Oncol. 2016;42(11):1720‐1728. https://doi.org/10.1016/j.ejso.2016.03.029
Yablonsky P, Pischik V, Tovbina MG, Atiukov M. The results of video-assisted thoracoscopic thymectomies in Saint Petersburg, Russia: 20-year of experience. J Vis Surg. 2017;3:113. https://doi.org/10.21037/jovs.2017.06.13
Allakhverdiev A.K., Davydov M.M., Ketsba A.S. Thoracoscopic thymectomy — procedure of choice for noninvasive thymoma. Endoscopic Surgery. 2017;6:3-9. (In Russ.). https://doi.org/10.17116/endoskop20172363-8
Dzidzava I.I., Dmitrochenko I.V., Kotiv B.N., Fufaev E.E., Yasyuchenya D.A., Trofimenko K.S., Apollonov A.A. Comparative analysis of «open» and video-assisted surgery for tumors of the thymus gland. Health. Medical ecology. Science. 2017;2(69):27-32. (In Russ.). https://doi.org/10.5281/zenodo.835806
Kurganov I.A., Panchenkov D.N., Bogdanov D.Yu., Emelianov S.I., Ivanov Yu.V., Khabarov Yu.A., Urazovskyi N.Yu. Comparative analysis of thymectomies through videothoracoscopic and transsternal approaches. Endoscopic Surgery. 2018;2:21-29. (In Russ.). https://doi.org/10.17116/endoskop201824221
Sigal E.I., Sigal R.E., Sigal A.M., Burmistrov M.V., Potanin V.P. Results of videothorascopic thymectomy used for patients with thymoma-associated myasthenia. Povolzhskii onkologicheskii vestnik. 2015;2:11-17. (In Russ.).
Topolnitskiy E.B., Borodina Yu.A. Videothoracoscopic interventions for tumors and cysts of the mediastinum. Endoscopic Surgery. 2020;26(6):17-21. (In Russ.). https://doi.org/10.17116/endoskop20202606117
Podobed A.V., Kurchin V.P., Bambiza A.V., Savchenko O.G., Malkevich V.T. Comparative analysis of immediate results of video-assisted thoracoscopic and open thymectomies in the treatment of stage I—II thymomas. Pirogov Russian Journal of Surgery. 2021;7: 31-35. https://doi.org/10.17116/hirurgia202105131
Kent MS, Wang T, Gangadharan SP, Whyte RI. What is the prevalence of a “nontherapeutic” thymectomy? Ann Thorac Surg. 2014;97(1):276-282. https://doi.org/10.1016/j.athoracsur.2013.07.121
Aleksandrov OA, Stepanov SA, Pikin OV, Volchenko NN, Solovyev VA, Bespalov PD, Vursol DA. Ultrasound-guided transthoracic core-needle biopsy of mediastinal tumors. P.A. Herzen Journal of Oncology. 2019;8(2):88-93. (In Russ.). https://doi.org/10.17116/onkolog2019802188
Weissferdt A, Moran CA. The spectrum of ectopic thymomas. Virchows Arch. 2016;469(3):245-254. https://doi.org/10.1007/s00428-016-1967-0
Guerrera F, Falcoz PE, Moser B, van Raemdonck D, Bille’ A, Toker A, Spaggiari L, Ampollini L, Filippini C, Thomas PA, Verdonck B, Mendogni P, Aigner C, Voltolini L, Novoa N, Patella M, Mantovani S, Bravio IG, Zisis C, Guirao A, Londero F, Congregado M, Rocco G, Du Pont B, Martucci N, Esch M, Brunelli A, Detterbeck FC, Venuta F, Weder W, Ruffini E; European Society of Thoracic Surgeons (ESTS) Thymic Working Group Participating Centers, Klepetko W, Olland A, Du Pont B, Nonaka D, Ozkan B, Lo Iacono G, Braggio C, Filosso PL, Brioude G, van Schil P, Nosotti M, Valdivia D, Bongiolatti S, Inci I, Dimitra R, Sànchez D, Grossi W, Moreno-Merino S, Teschner M. Thymomectomy plus total thymectomy versus simple thymomectomy for early-stage thymoma without myasthenia gravis: a European Society of Thoracic Surgeons Thymic Working Group Study. Eur J Cardiothorac Surg. 2021;60(4):881-887. https://doi.org/10.1093/ejcts/ezab224
Kim A, Choi SJ, Kang CH, Lee S, Son H, Kim JA, Shin JY, Kim SM, Hong YH, Sung JJ. Risk factors for developing post-thymectomy myasthenia gravis in patients with thymoma. Muscle Nerve. 2021;63(4):531-537. https://doi.org/10.1002/mus.27169

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