Download PDF
Thorac Cardiovasc Surg 2015; 63(03): 178-186
DOI: 10.1055/s-0034-1396083
Review
Georg Thieme Verlag KG Stuttgart · New York

Transsternal Thymectomy

Giulio Maurizi
1   Department of Thoracic Surgery, University La Sapienza, Sant'Andrea Hospital, Rome, Italy
,
Antonio D'Andrilli
1   Department of Thoracic Surgery, University La Sapienza, Sant'Andrea Hospital, Rome, Italy
,
Lorenzo Sommella
2   Sant'Andrea Hospital, Rome, Italy
,
Federico Venuta
3   Department of Thoracic Surgery, University La Sapienza, Policlinico Umberto I, Rome, Italy
4   Lorillard Spencer-Cenci Foundation, Rome, Italy
,
Erino A. Rendina
1   Department of Thoracic Surgery, University La Sapienza, Sant'Andrea Hospital, Rome, Italy
4   Lorillard Spencer-Cenci Foundation, Rome, Italy
› Author Affiliations
Further Information

Publication History

17 July 2014

06 October 2014

Publication Date:
12 December 2014 (online)

    Permissions and Reprints All articles of this category

Abstract

Thymectomy is a well-established indication for management of myasthenia gravis and it represents the most effective treatment for thymic tumors. The traditional surgical approach is median sternotomy. More recently, different less-invasive surgical approaches for thymectomy have been proposed as an alternative to open surgery. This article discusses the main technical aspects and results of literature.

Keywords

transsternal thymectomy - thymoma - myasthenia gravis
 

  • References

  • 1 Daniel VC, Wright CD. Extended transsternal thymectomy. Thorac Surg Clin 2010; 20 (2) 245-252
    CrossrefPubMedGoogle Scholar
  • 2 Cea G, Benatar M, Verdugo RJ, Salinas RA. Thymectomy for non-thymomatous myasthenia gravis. Cochrane Database Syst Rev 2013; 10: CD008111
    PubMedGoogle Scholar
  • 3 Davenport E, Malthaner RA. The role of surgery in the management of thymoma: a systematic review. Ann Thorac Surg 2008; 86 (2) 673-684
    CrossrefPubMedGoogle Scholar
  • 4 Venuta F, Rendina EA, Anile M, de Giacomo T, Vitolo D, Coloni GF. Thymoma and thymic carcinoma. Gen Thorac Cardiovasc Surg 2012; 60 (1) 1-12
    PubMedGoogle Scholar
  • 5 Wang LS, Huang MH, Lin TS, Huang BS, Chien KY. Malignant thymoma. Cancer 1992; 70 (2) 443-450
    CrossrefPubMedGoogle Scholar
  • 6 Deeb ME, Brinster CJ, Kucharzuk J, Shrager JB, Kaiser LR. Expanded indications for transcervical thymectomy in the management of anterior mediastinal masses. Ann Thorac Surg 2001; 72 (1) 208-211
    CrossrefPubMedGoogle Scholar
  • 7 Shrager JB. Extended transcervical thymectomy: the ultimate minimally invasive approach. Ann Thorac Surg 2010; 89 (6) S2128-S2134
    CrossrefPubMedGoogle Scholar
  • 8 Wei B, D'Amico TA. Thoracoscopic versus robotic approaches: advantages and disadvantages. Thorac Surg Clin 2014; 24 (2) 177-188 , vi
    CrossrefPubMedGoogle Scholar
  • 9 Schwartz GS, Yang SC. Robotic thymectomy for thymic neoplasms. Thorac Surg Clin 2014; 24 (2) 197-201 , vii
    CrossrefPubMedGoogle Scholar
  • 10 Ismail M, Swierzy M, Rückert RI, Rückert JC. Robotic thymectomy for myasthenia gravis. Thorac Surg Clin 2014; 24 (2) 189-195 , vi–vii
    CrossrefPubMedGoogle Scholar
  • 11 Venuta F, de Giacomo T, Andreetti C, Furio Coloni G. Transsternal thymoma resection. Multimed Man Cardiothorac Surg 2005; 2005 (425) 000182
    PubMedGoogle Scholar
  • 12 Keshavjee S, Finley C. The Optimal Approach for Resection of Encapsulated Thymoma: Open versus VATS. Difficult Decision in Thoracic Surgery. London: Springer-Verlag; 2011
    Google Scholar
  • 13 Kaminski HJ. Myastenia Gravis and Related Disorders. Totowa, NJ: Humana Press; 2003
    CrossrefGoogle Scholar
  • 14 Newson-Davis J, Beeson D. Myasthenia Gravis and Myasthenic Syndromes: Autoimmune and Genetic Disorders. Disorders of Voluntary Muscle. Cambridge: Cambridge University Press; 2001: 660-675
    Google Scholar
  • 15 Monden Y, Nakahara K, Kagotani K, Fujii Y, Masaoka A, Kawashima Y. Myasthenia gravis with thymoma: analysis of and postoperative prognosis for 65 patients with thymomatous myasthenia gravis. Ann Thorac Surg 1984; 38 (1) 46-52
    CrossrefPubMedGoogle Scholar
  • 16 Davis Jr RD, Oldham Jr HN, Sabiston Jr DC. Primary cysts and neoplasms of the mediastinum: recent changes in clinical presentation, methods of diagnosis, management, and results. Ann Thorac Surg 1987; 44 (3) 229-237
    CrossrefPubMedGoogle Scholar
  • 17 Mullen B, Richardson JD. Primary anterior mediastinal tumors in children and adults. Ann Thorac Surg 1986; 42 (3) 338-345
    CrossrefPubMedGoogle Scholar
  • 18 Valli M, Fabris GA, Dewar A , et al. Atypical carcinoid tumour of the thymus: a study of eight cases. Histopathology 1994; 24 (4) 371-375
    CrossrefPubMedGoogle Scholar
  • 19 Detterbeck F, Parsons AM. Thymic Tumors: A Review of Current Diagnosis, Classification, and Treatment. Thoracic and Esophageal Surgery. 3rd ed. Philadelphia, PA: Elsevier; 2008: 1589-1614
    Google Scholar
  • 20 Regnard J-F, Magdeleinat P, Dromer C , et al. Prognostic factors and long-term results after thymoma resection: a series of 307 patients. J Thorac Cardiovasc Surg 1996; 112 (2) 376-384
    CrossrefPubMedGoogle Scholar
  • 21 Jaretzki III A. Thymectomy for myasthenia gravis: analysis of controversies regarding technique and results. Neurology 1997; 48 (Suppl. 05) S52-S63
    CrossrefPubMedGoogle Scholar
  • 22 Jaretzki III A, Penn AS, Younger DS , et al. “Maximal” thymectomy for myasthenia gravis. Results. J Thorac Cardiovasc Surg 1988; 95 (5) 747-757
    PubMedGoogle Scholar
  • 23 Jaretzki III A, Wolff M. “Maximal” thymectomy for myasthenia gravis. Surgical anatomy and operative technique. J Thorac Cardiovasc Surg 1988; 96 (5) 711-716
    PubMedGoogle Scholar
  • 24 Ye B, Tantai JC, Ge XX , et al. Surgical techniques for early-stage thymoma: video-assisted thoracoscopic thymectomy versus transsternal thymectomy. J Thorac Cardiovasc Surg 2014; 147 (5) 1599-1603
    CrossrefPubMedGoogle Scholar
  • 25 Yuan ZY, Cheng GY, Sun KL , et al. Comparative study of video-assisted thoracic surgery versus open thymectomy for thymoma in one single center. J Thorac Dis 2014; 6 (6) 726-733
    PubMedGoogle Scholar
  • 26 Jurado J, Javidfar J, Newmark A , et al. Minimally invasive thymectomy and open thymectomy: outcome analysis of 263 patients. Ann Thorac Surg 2012; 94 (3) 974-981 , discussion 981–982
    CrossrefPubMedGoogle Scholar
  • 27 Pennathur A, Qureshi I, Schuchert MJ , et al. Comparison of surgical techniques for early-stage thymoma: feasibility of minimally invasive thymectomy and comparison with open resection. J Thorac Cardiovasc Surg 2011; 141 (3) 694-701
    CrossrefPubMedGoogle Scholar
  • 28 Diaz A, Black E, Dunning J. Is thymectomy in non-thymomatous myasthenia gravis of any benefit?. Interact Cardiovasc Thorac Surg 2014; 18 (3) 381-389
    CrossrefPubMedGoogle Scholar
  • 29 Bacha EA, Chapelier AR, Macchiarini P, Fadel E, Dartevelle PG. Surgery for invasive primary mediastinal tumors. Ann Thorac Surg 1998; 66 (1) 234-239
    CrossrefPubMedGoogle Scholar
  • 30 Chen KN, Xu SF, Gu ZD , et al. Surgical treatment of complex malignant anterior mediastinal tumors invading the superior vena cava. World J Surg 2006; 30 (2) 162-170
    CrossrefPubMedGoogle Scholar
  • 31 Baskett RJ, MacDougall CE, Ross DB. Is mediastinitis a preventable complication? A 10-year review. Ann Thorac Surg 1999; 67 (2) 462-465
    CrossrefPubMedGoogle Scholar
  • 32 Demmy TL, Park SB, Liebler GA , et al. Recent experience with major sternal wound complications. Ann Thorac Surg 1990; 49 (3) 458-462
    CrossrefPubMedGoogle Scholar
  • 33 Weber LD, Peters RW. Delayed chest wall complications of median sternotomy. South Med J 1986; 79 (6) 723-727
    CrossrefPubMedGoogle Scholar
  • 34 D'Andrilli A, Ciccone AM, Ibrahim M, Venuta F, Rendina EA. A new technique for prosthetic reconstruction of the superior vena cava. J Thorac Cardiovasc Surg 2006; 132 (1) 192-194
    CrossrefPubMedGoogle Scholar
  • 35 Penn AS. Thymectomy for Myasthenia Gravis. Handbook of Myasthenia Gravis and Myasthenic Syndrome. New York: Marcel Dekker; 1994: 321-339
    Google Scholar
  • 36 Buzzard EF. The clinical history and postmortem examination of five cases of myasthenia gravis. Brain 1905; 28: 438-483
    PubMedGoogle Scholar
  • 37 Sonett JR, Jaretzki III A. Thymectomy for nonthymomatous myasthenia gravis: a critical analysis. Ann N Y Acad Sci 2008; 1132: 315-328
    CrossrefPubMedGoogle Scholar
  • 38 Gronseth GS, Barohn RJ. Practice parameter: thymectomy for autoimmune myasthenia gravis (an evidence-based review): report of the Quality Standards Subcommittee of the American Academy of Neurology. Neurology 2000; 55 (1) 7-15
    CrossrefPubMedGoogle Scholar
  • 39 Lanska DJ. Indications for thymectomy in myasthenia gravis. Neurology 1990; 40 (12) 1828-1829
    CrossrefPubMedGoogle Scholar
  • 40 Jaretzki III A, Barohn RJ, Ernstoff RM , et al; Task Force of the Medical Scientific Advisory Board of the Myasthenia Gravis Foundation of America. Myasthenia gravis: recommendations for clinical research standards. Neurology 2000; 55 (1) 16-23
    CrossrefPubMedGoogle Scholar
  • 41 Mantegazza R, Baggi F, Bernasconi P , et al. Video-assisted thoracoscopic extended thymectomy and extended transsternal thymectomy (T-3b) in non-thymomatous myasthenia gravis patients: remission after 6 years of follow-up. J Neurol Sci 2003; 212 (1–2) 31-36
    CrossrefPubMedGoogle Scholar
  • 42 Chang PC, Chou SH, Kao EL , et al. Bilateral video-assisted thoracoscopic thymectomy vs. extended transsternal thymectomy in myasthenia gravis: a prospective study. Eur Surg Res 2005; 37 (4) 199-203
    CrossrefPubMedGoogle Scholar
  • 43 Maggi L, Andreetta F, Antozzi C , et al. Thymoma-associated myasthenia gravis: outcome, clinical and pathological correlations in 197 patients on a 20-year experience. J Neuroimmunol 2008; 201-202: 237-244, 237–244
    CrossrefPubMedGoogle Scholar
  • 44 Lin MW, Chang YL, Huang PM, Lee YC. Thymectomy for non-thymomatous myasthenia gravis: a comparison of surgical methods and analysis of prognostic factors. Eur J Cardiothorac Surg 2010; 37 (1) 7-12
    CrossrefPubMedGoogle Scholar
  • 45 Masaoka A, Monden Y, Nakahara K, Tanioka T. Follow-up study of thymomas with special reference to their clinical stages. Cancer 1981; 48 (11) 2485-2492
    CrossrefPubMedGoogle Scholar
  • 46 Pan C-C, Wu H-P, Yang C-F, Chen WY, Chiang H. The clinicopathological correlation of epithelial subtyping in thymoma: a study of 112 consecutive cases. Hum Pathol 1994; 25 (9) 893-899
    CrossrefPubMedGoogle Scholar
  • 47 Maggi G, Casadio C, Cavallo A, Cianci R, Molinatti M, Ruffini E. Thymoma: results of 241 operated cases. Ann Thorac Surg 1991; 51 (1) 152-156
    CrossrefPubMedGoogle Scholar
  • 48 Verley JM, Hollmann KH. Thymoma. A comparative study of clinical stages, histologic features, and survival in 200 cases. Cancer 1985; 55 (5) 1074-1086
    CrossrefPubMedGoogle Scholar
  • 49 Kondo K, Yoshizawa K, Tsuyuguchi M , et al. WHO histologic classification is a prognostic indicator in thymoma. Ann Thorac Surg 2004; 77 (4) 1183-1188
    CrossrefPubMedGoogle Scholar
  • 50 Park MS, Chung KY, Kim KD , et al. Prognosis of thymic epithelial tumors according to the new World Health Organization histologic classification. Ann Thorac Surg 2004; 78 (3) 992-997 , discussion 997–998
    CrossrefPubMedGoogle Scholar
  • 51 Chen G, Marx A, Chen WH , et al. New WHO histologic classification predicts prognosis of thymic epithelial tumors: a clinicopathologic study of 200 thymoma cases from China. Cancer 2002; 95 (2) 420-429
    CrossrefPubMedGoogle Scholar
  • 52 Ströbel P, Bauer A, Puppe B , et al. Tumor recurrence and survival in patients treated for thymomas and thymic squamous cell carcinomas: a retrospective analysis. J Clin Oncol 2004; 22 (8) 1501-1509
    CrossrefPubMedGoogle Scholar
  • 53 Nakahara K, Ohno K, Hashimoto J , et al. Thymoma: results with complete resection and adjuvant postoperative irradiation in 141 consecutive patients. J Thorac Cardiovasc Surg 1988; 95 (6) 1041-1047
    PubMedGoogle Scholar
  • 54 Wilkins KB, Sheikh E, Green R , et al. Clinical and pathologic predictors of survival in patients with thymoma. Ann Surg 1999; 230 (4) 562-572 , discussion 572–574
    CrossrefPubMedGoogle Scholar
  • 55 Elert O, Buchwald J, Wolf K. Epithelial thymus tumors—therapy and prognosis. Thorac Cardiovasc Surg 1988; 36 (2) 109-113
    Article in Thieme ConnectPubMedGoogle Scholar
  • 56 Ogawa K, Uno T, Toita T , et al. Postoperative radiotherapy for patients with completely resected thymoma: a multi-institutional, retrospective review of 103 patients. Cancer 2002; 94 (5) 1405-1413
    CrossrefPubMedGoogle Scholar
  • 57 Blumberg D, Port JL, Weksler B , et al. Thymoma: a multivariate analysis of factors predicting survival. Ann Thorac Surg 1995; 60 (4) 908-913 , discussion 914
    CrossrefPubMedGoogle Scholar
  • 58 Okumura M, Ohta M, Tateyama H , et al. The World Health Organization histologic classification system reflects the oncologic behavior of thymoma: a clinical study of 273 patients. Cancer 2002; 94 (3) 624-632
    CrossrefPubMedGoogle Scholar
  • 59 Maggi G, Giaccone G, Donadio M , et al. Thymomas. A review of 169 cases, with particular reference to results of surgical treatment. Cancer 1986; 58 (3) 765-776
    CrossrefPubMedGoogle Scholar
  • 60 Okumura M, Miyoshi S, Takeuchi Y , et al. Results of surgical treatment of thymomas with special reference to the involved organs. J Thorac Cardiovasc Surg 1999; 117 (3) 605-613
    CrossrefPubMedGoogle Scholar
  • 61 Lewis JE, Wick MR, Scheithauer BW, Bernatz PE, Taylor WF. Thymoma. A clinicopathologic review. Cancer 1987; 60 (11) 2727-2743
    CrossrefPubMedGoogle Scholar
  • 62 Myojin M, Choi NC, Wright CD , et al. Stage III thymoma: pattern of failure after surgery and postoperative radiotherapy and its implication for future study. Int J Radiat Oncol Biol Phys 2000; 46 (4) 927-933
    CrossrefPubMedGoogle Scholar
  • 63 Rea F, Marulli G, Girardi R , et al. Long-term survival and prognostic factors in thymic epithelial tumours. Eur J Cardiothorac Surg 2004; 26 (2) 412-418
    CrossrefPubMedGoogle Scholar
  • 64 Wilkins Jr EW, Grillo HC, Scannell JG, Moncure AC, Mathisen DJ. J. Maxwell Chamberlain Memorial Paper. Role of staging in prognosis and management of thymoma. Ann Thorac Surg 1991; 51 (6) 888-892
    CrossrefPubMedGoogle Scholar
  • 65 Crucitti F, Doglietto GB, Bellantone R, Perri V, Tommasini O, Tonali P. Effects of surgical treatment in thymoma with myasthenia gravis: our experience in 103 patients. J Surg Oncol 1992; 50 (1) 43-46
    CrossrefPubMedGoogle Scholar
  • 66 Kirschner PA. Reoperation for thymoma: report of 23 cases. Ann Thorac Surg 1990; 49 (4) 550-554 , discussion 555
    CrossrefPubMedGoogle Scholar
  • 67 Zhu G, He S, Fu X, Jiang G, Liu T. Radiotherapy and prognostic factors for thymoma: a retrospective study of 175 patients. Int J Radiat Oncol Biol Phys 2004; 60 (4) 1113-1119
    CrossrefPubMedGoogle Scholar
  • 68 Nakagawa K, Asamura H, Matsuno Y , et al. Thymoma: a clinicopathologic study based on the new World Health Organization classification. J Thorac Cardiovasc Surg 2003; 126 (4) 1134-1140
    CrossrefPubMedGoogle Scholar
  • 69 D'Andrilli A, Venuta F, Rendina EA. Surgical approaches for invasive tumors of the anterior mediastinum. Thorac Surg Clin 2010; 20 (2) 265-284
    CrossrefPubMedGoogle Scholar
  • 70 Fujino S, Tezuka N, Watarida S, Katsuyama K, Inoue S, Mori A. Reconstruction of the aortic arch in invasive thymoma under retrograde cerebral perfusion. Ann Thorac Surg 1998; 66 (1) 263-264
    CrossrefPubMedGoogle Scholar
  • 71 Cheng YJ. Videothoracoscopic resection of encapsulated thymic carcinoma: retrospective comparison of the results between thoracoscopy and open methods. Ann Surg Oncol 2008; 15 (8) 2235-2238
    CrossrefPubMedGoogle Scholar
  • 72 Sakamaki Y, Oda T, Kanazawa G, Shimokawa T, Kido T, Shiono H. Intermediate-term oncologic outcomes after video-assisted thoracoscopic thymectomy for early-stage thymoma. J Thorac Cardiovasc Surg 2014; 148 (4) 1230-1237.e1
    CrossrefPubMedGoogle Scholar
  • 73 Limmer KK, Kernstine KH. Minimally invasive and robotic-assisted thymus resection. Thorac Surg Clin 2011; 21 (1) 69-83 , vii
    CrossrefPubMedGoogle Scholar
  • 74 Marulli G, Rea F, Melfi F , et al. Robot-aided thoracoscopic thymectomy for early-stage thymoma: a multicenter European study. J Thorac Cardiovasc Surg 2012; 144 (5) 1125-1130
    CrossrefPubMedGoogle Scholar
  • 75 Manoly I, Whistance RN, Sreekumar R , et al. Early and mid-term outcomes of trans-sternal and video-assisted thoracoscopic surgery for thymoma. Eur J Cardiothorac Surg 2014; 45 (6) e187-e193
    CrossrefPubMedGoogle Scholar
  • 76 Liu TJ, Lin MW, Hsieh MS , et al. Video-assisted thoracoscopic surgical thymectomy to treat early thymoma: a comparison with the conventional transsternal approach. Ann Surg Oncol 2014; 21 (1) 322-328
    CrossrefPubMedGoogle Scholar
  • 77 Detterbeck FC, Parsons AM. Management of stage I and II thymoma. Thorac Surg Clin 2011; 21 (1) 59-67 , vi–vii
    CrossrefPubMedGoogle Scholar
  • 78 Haniuda M, Miyazawa M, Yoshida K , et al. Is postoperative radiotherapy for thymoma effective?. Ann Surg 1996; 224 (2) 219-224
    CrossrefPubMedGoogle Scholar
  • 79 Urgesi A, Monetti U, Rossi G, Ricardi U, Maggi G, Sannazzari GL. Aggressive treatment of intrathoracic recurrences of thymoma. Radiother Oncol 1992; 24 (4) 221-225
    CrossrefPubMedGoogle Scholar
  • 80 Pompeo E, Tacconi F, Massa R, Mineo D, Nahmias S, Mineo TC. Long-term outcome of thoracoscopic extended thymectomy for nonthymomatous myasthenia gravis. Eur J Cardiothorac Surg 2009; 36 (1) 164-169
    CrossrefPubMedGoogle Scholar