Single-centre 40-year results of redo operation for recurrent thymomas

Abstract

Objective: Modes of treatment for recurrent thymoma remain controversial. The aim of this study is to analyse the early and long-term results of surgical intervention for this condition.

Methods: Between 1972 and 2008, 43 out of 315 patients, who underwent resection with radical intent for thymoma, subsequently relapsed. Of these, 30 cases were deemed suitable for resection and operation, and were surgically treated. The remaining 13 were treated with radio- and/or chemotherapy (RT/CT). Overall outcomes for long-term survival up to 5 years (LTS) and disease-free survival (DFS) were analysed using standard statistics.

Results: The average age of the relapsed patients was 54.7±12.7 years. There were 21 males and 22 females. Forty out of the 43 had myasthenia gravis (MG). Fifteen cases concerned a single detected relapse lesion. Among the 43 patients, relapses were found in the following sites: pleura (25 cases), mediastinum (12), lung (five), liver and bone (one). The perioperative mortality was 0% and the morbidity was 27%. Twenty-two of the surgically treated patients had complete resection; their LTS was 77% and DFS was 71%. Those patients who underwent surgery had significantly better outcomes compared with patients treated with radio- and/or chemotherapy (LTS only 35%; hazard ratio (HR): 0.22; 95% confidence interval (CI): 0.08-0.59; p=0.001). Complete repeated resection yielded much better outcomes than partial resection (LTS 91% vs 31%, p<0.001), whereas incomplete resection was associated, as one might expect, with a poor prognosis (HR: 6.12; 95% CI: 1.18-31.55; p=0.031). No evidence for an association with other clinical, surgical and pathological characteristics was found with regard to LTS or DFS.

Conclusions: Surgical resection is recommended for the treatment of recurrent thymoma, provided that criteria for suitability for resection/operation are satisfactory at the time of diagnosis. Best survival outcomes are found to depend on the degree of completeness of the repeat resection.