Surgical and Oncological Outcomes in Locally Advanced Thymoma

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Abstract
This study aimed at reporting the surgical management of locally advanced thymoma (Masaoka stages III and IVA) and evaluating the factors predicting the survival. This is a retrospective analysis of patients operated for locally advanced thymoma from March 2012 to December 2019 in a thoracic surgery center in India. An analysis of all perioperative variables including complications was carried out. The influence of various predictors on survival was assessed by log-rank test. Out of total 54 patients, 42 (77.8%) had stage III and 12 (22.2%) had stage IVA. Upfront surgery was done in 34 (63%) patients, and induction chemotherapy was given in 20 (37%) patients. Pericardium was the commonest structure resected (79.6%) followed by the lung (51.8%), phrenic nerve (48.1%), major vascular structures (40.7%), parietal pleura (22.2%), diaphragm (9.2%), and right atrial appendage (1.8%). Forty-seven (87%) cases had complete (R0) resection, and the remaining 7 (12.9%) cases had incomplete (R1/R2) resection. There were no perioperative deaths (< 90 days). The median follow-up was 58 months. Overall survival (OS) and disease-free survival (DFS) at 5 years were 77.8% and 75.9%. Higher age (> 60 years), incomplete surgical resection, type B histology, and “> 3” structures resected with tumor were the poor prognostic factors for survival. An aggressive surgical approach, by an experienced team of cardiac and thoracic surgeons, aimed at complete resection is vitally important and can achieve excellent surgical and oncological outcomes even in locally advanced thymomas.

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