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. 2017 Mar;9(3):725-733.
doi: 10.21037/jtd.2017.03.03.

Reconstruction of mediastinal vessels for invasive thymoma: a retrospective analysis of 25 cases

Yifeng Sun  1 , Chang Gu  1 , Jianxin Shi  1 , Wentao Fang  1 , Qingquan Luo  2 , Dingzhong Hu  1 , Shijie Fu  1 , Xufeng Pan  1 , Yong Chen  1 , Yu Yang  1 , Haitang Yang  1 , Heng Zhao  1 , Haiquan Chen  1   3
Affiliations

Reconstruction of mediastinal vessels for invasive thymoma: a retrospective analysis of 25 cases

Yifeng Sun et al. J Thorac Dis. 2017 Mar.

Abstract

Background: Discuss an appropriate strategy for treatment of invasive thymoma invading adjacent great vessels.

Methods: A retrospective study on 25 patients with invasive thymoma invading neighboring great vessels was performed. The corresponding data including clinical presentation, operation procedure, adjuvant radio-chemotherapy and follow-up were reviewed.

Results: Twenty of 25 (80%) patients with invasive thymoma underwent complete resection of the tumor along with vessel reconstruction. Intraoperatively, different types of operation were conducted, namely, brachiocephalic vein (BCV)-right atrial appendage (RAA) reconstruction in 11 cases, complex vessel reconstruction (more than one graft) in 1 case and superior vena cava (SVC)-SVC reconstruction in the remaining cases. Ringed polytetrafluoroethylene (PTFE) grafts were used for vessel reconstruction. Postoperatively, three cases suffered from pulmonary infection, and three cases had haemothorax, chylothorax and atelectasis, respectively. Two patients died due to acute respiratory distress syndrome within 90 days after the surgery. Within the remaining patients, 11 cases (44%) experienced a relapse and finally 8 (32%) patients died. Compared to R1 resection group, R0 resection group had a better prognosis (Log-rank P=0.0196). The 3- and 5-year survival rates were 79.6% and 59.1%, with median survival time of 84 months.

Conclusions: Reconstruction of mediastinal vessels for invasive thymoma is a feasible technology method. Radical resection of the tumor with involved neighboring structures is the key to prolong overall survival for patients suffered from invasive thymoma.

Keywords: Invasive thymoma; prognosis; vessel reconstruction.

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Conflict of interest statement

Conflicts of Interest: The authors have no conflicts of interest to declare.

Figures

Figure 1
Figure 1
Representative image of contrast-enhanced tomography of the invasive thymoma, which invading superior vena cava (Case 15, Type B3, Stage IVA).
Figure 2
Figure 2
The distributions of WHO type and Masaoka’s stage in our patients.
Figure 3
Figure 3
A brief schematic diagram showing vessel involved by invasive thymoma (a) and the procedure of reconstruction (b). Picture 1 shows invasion of SVC and left BCV and reconstruction with ringed PTFE grafts (case 14, 15); picture 2 shows invasion of SVC, left and right BCV and reconstruction with ringed PTFE grafts (case 2); picture 3 shows invasion of right BCV and reconstruction with ringed PTFE grafts (case 3, 6, 9); picture 4 shows invasion of left BCV and reconstruction with ringed PTFE grafts (case 5, 10, 12, 16, 21, 22); picture 5 shows invasion of SVC and reconstruction with ringed PTFE grafts (the remaining cases). SVC, superior vena cava; BCV, brachiocephalic vein; PTFE, polytetrafluoroethylene.
Figure 4
Figure 4
Survival curves for RFS (A) and OS (B) according to patients in our series. RFS, relapse-free survival; OS, overall survival.
Figure 5
Figure 5
OS curve between R1 resection group and R0 resection group. OS, overall survival.
See this image and copyright information in PMC

References

    1. Cohen DJ, Ronnigen LD, Graeber GM, et al. Management of patients with malignant thymoma. J Thorac Cardiovasc Surg 1984;87:301-7. - PubMed
    1. Pastorino U, Yang XN, Francese M, et al. Long-term survival after salvage surgery for invasive thymoma with intracardiac extension. Tumori 2008;94:772-6. - PubMed
    1. Engels EA, Pfeiffer RM. Malignant thymoma in the United States: demographic patterns in incidence and associations with subsequent malignancies. Int J Cancer 2003;105:546-51. 10.1002/ijc.11099 - DOI - PubMed
    1. Travis WD, Brambilla E, Müller-Hermelink HK, et al. (editors). Organization Classification of Tumours. Pathology and Genetics of Tumours of the Lung, Pleura, Thymus and Heart. Lyon: IARC Press, 2004:146-7.
    1. Marx A, Ströbel P, Badve SS, et al. ITMIG consensus statement on the use of the WHO histological classification of thymoma and thymic carcinoma: refined definitions, histological criteria, and reporting. J Thorac Oncol 2014;9:596-611. 10.1097/JTO.0000000000000154 - DOI - PubMed

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