A Systematic Review of Heated Intrathoracic Chemotherapy for Thymic Epithelial Tumors and the First Case Report of a Robotic Approach: Could a Minimally Invasive Approach Offer a New Paradigm of Care?

Abstract

Background/Objectives: Thymic epithelial tumors with pleural metastasis require a multimodal treatment approach with the use of novel modalities such as hyperthermic intrathoracic chemotherapy (HITHOC). This systematic review and case report aims to summarize the existing evidence regarding HITHOC for these tumors and presents the first case of a robotic approach to HITHOC. Methods: A search in November 2023 yielded a total of 17 articles, including 281 patients who met the eligibility criteria (i.e., underwent HITHOC for treatment of a thymic epithelial tumor). Results: Variations existed among HITHOC regimens and surgical approaches. The most common complications observed were air leaks. Overall survival ranged 92-95% at 1 year, 83-91.7% at 3 years, 66.7-92% at 5 years, 40-83.3% at 10 years, and 27.8-58.2% at 15 years. Conclusions: While HITHOC for thymic epithelial tumors with pleural dissemination has been shown to yield successful outcomes in the literature, this procedure has historically been performed almost exclusively via an open thoracotomy. The robotic approach to HITHOC is feasible and affords several important benefits.

Keywords: HITHOC; robotic-assisted surgery; thoracic surgery; thymic cancer; thymic neoplasia.

Figure 1

PRISMA Flowchart for study selection.

Figure 2

Inflow and outflow ports of the HITHOC system. The inflow ports actively pump solution into the peritoneal cavity, while the outflow port passively drains the fluid, maintaining a closed-loop, continuation circulation.