P37. Surgical strategy for stage III thymoma by video assisted thoracoscopic surgery (VAT-T) with lateral thoracotomy

Background: Whether thoracoscopic surgical treatment is acceptable for invasive thymoma, one of main anterior mediastinal tumor remains to be still controversial. However, we performed the video-assisted thoracoscopic surgery for Masaoka stage III thymoma invaded to adjacent organs after acquisition of the patient permission. We examined the feasibility and efficacy of video-assissted thoracoscopic thymectomy (VAT-T) with lateral thoracotomy for stage III thymoma.

Methods: We evaluated the short-term outcomes of eight cases undergoing surgery for stage III thymoma without myasthenia gravis between 2007 and 2014. A part of stage III thymoma occurred in lower pole of the thymus, which locally invaded the lung, the pericardium and the left brachiocephalic vein was selected for this technique. Of these, five cases were operated via right thoracic cavity, and three cases were operated via left thoracic cavity. Lateral thoracotomy was done at fourth or fifth intercostal space. One or two thoracoscopic ports were inserted at sixth or seventh intercostal space on the anterior axillary line. We inserted unilateral hand into thoracic cavity adequately and touched the tumor directly under thoracoscopic vision. As for resection of upper pole of thymus, some cases were carried out using chest wall lifting method by the kirchner wires inserted under the skin on the sternum.

Results: The pathological examination showed that type B1 in three cases, type B3 in three cases, and type C in two cases. In all cases tumor cells at surgical margin could not found pathologically. Postoperative radiation was carried out in one case. Invasion organs were lung in six cases, pericardium in five cases, and left brachiocephalic vein in two cases. Postoperatively, only one case had pleural disseminations, and chemotherapy was carried out. No patient in this group underwent conversion to median sternotomy. No surgical complications and postoperative complications were detected. The median follow-up period was 4.3 years (range, 0.3-7.3 years). All patients are alive in present.

Conclusions: The operative wound and postoperative activities of daily life (ADL) was very satisfactory to all patients. These results suggest that VAT-T with lateral thoracotomy for a part of stage III thymoma is safe and reasonable postoperative outcomes. VAT-T with lateral thoracotomy may confer some advantages over conventional methods of standard median sternotomy.

Keywords: Thymoma; stage III; surgery