Thymomectomy versus complete thymectomy in early-stage non-myasthenic thymomas: a multicentric propensity score-matched study. (20th June 2022)

• Record Type: Journal Article
• Authors: Voulaz, Emanuele; Perroni, Gianluca; Russo, Anna; Patirelis, Alexandro; Mangiameli, Giuseppe; Alloisio, Marco; Ambrogi, Vincenzo
• Is Part Of: Interactive cardiovascular and thoracic surgery. Volume 35:Number 1(2022)
• Publication Date: 2022-06-20
• Subjects: Thymoma -- Surgery -- Thymomectomy -- Complete thymectomy -- Myasthenia gravis; Chest -- Surgery -- Periodicals; Cardiovascular system -- Diseases -- Periodicals; 616.1
• DOI: 10.1093/icvts/ivac167
• Languages: English
• ISSNs: 1569-9293

Abstract

Abstract: OBJECTIVES: Thymomectomy is gaining consensus over complete thymectomy in early-stage thymoma without myasthenia gravis. This is due both to the difficulty of establishing prospective and randomized controlled studies and to the lack of well-defined selection criteria. This bicentric, retrospective propensity score-matched study aims at comparing oncological outcomes, measured in terms of overall survival and thymoma-related survival, in patients undergoing either thymomectomy or complete thymectomy. METHODS: We retrospectively analysed medical records of patients with clinical early-stage (I and II) thymoma undergoing thymomectomy or complete thymectomy. Exclusion criteria were the presence of myasthenia gravis, clinical advanced tumours and thymic carcinoma. A propensity score-matching analysis was applied to reduce potential preoperative selection biases such as comorbidity (Charlson score), tumour maximal diameter and surgical approach (open versus minimal). All variables were dichotomized. RESULTS: A total of 255 patients were enrolled from 2 different Hospitals, 126 underwent complete thymectomy and 129 a thymomectomy. Disease-free and thymoma-related survivals showed a 5-year rate of 87.7% and 96.0% and a 10-year rate of 82.2% and 91.9%, respectively. Propensity score-matching analysis selected a total of 176 patients equally divided between the 2 groups. No difference was found for both disease-free ( P = 0.11) and thymoma-related ( P = 0.37) survival in the 2 groups of resection. Multivariable Cox regression analysis showed that histology ( P < 0.001), residual disease ( P < 0.001) and adjuvant chemotherapy ( P < 0.001) were the only predictors of shorter disease-free survival. Whereas there was no evidence to confirm that disease-free and thymoma-related survivals were influenced by resection extent. CONCLUSIONS: Thymomectomy is an adequate surgical resection for non-myasthenic thymoma, achieving disease-free and thymoma-related survivals comparable to those after complete thymectomy. Abstract : The extent of thymic resection in case of thymoma is still matter of debate.