Thymoma and Thymic Carcinoma: Surgical Resection and Multidisciplinary Treatment

SIMPLE SUMMARY: Surgery is the main treatment for thymic tumors, and multidisciplinary treatment would benefit patients a lot. Despite numerous technological advances in the surgical treatment of thymic tumors, a number of contentious issues remain, including the selection of surgical approaches for difficult cases, the selection of Video-assisted Thoracoscopic Surgery approaches, the evaluation of resectability, minimal invasive surgery for locally advanced thymic tumors, lymphadenectomy in thymic tumors, neoadjuvant therapy, debulking surgery, salvage surgery, etc. In solving these problems, the surgeon’s judgment, surgical experience, and surgical skills are especially important; we discuss these debatable issues and share our experience about it which may give some ideas and help to the surgeons working on thymic tumors. ABSTRACT: Thymoma and thymic carcinoma are the most common tumors of the anterior mediastinum and a relatively rare type of thoracic cancer. The prerequisite for surgery is clinical staging and operative evaluation, both of which are based on medical imaging. The best strategy for treating a thymic epithelial tumor is surgical resection of the organ and surrounding tissue. Thymectomy modalities vary, including open surgery and minimally invasive surgery, and surgeons have used various innovations to better meet the needs of the procedure; therefore, it is critical to select the appropriate procedure based on the patient’s characteristics. Evaluation of resectability is the first step of surgical resection for thymic tumors without distant metastasis. The decision regarding unresectability should be made carefully. During subsequent chemotherapy or chemoradiotherapy, reevaluation of whether an area is resectable or not remains essential. Despite numerous technological advances in the surgical treatment of thymic tumors, several contentious issues remain, including the selection of surgical approaches for difficult cases, the selection of video-assisted thoracoscopic approaches, the evaluation of resectability, minimally invasive surgery for locally advanced thymic tumors, lymphadenectomy in thymic tumors, neoadjuvant therapy for thymic tumors, debulking surgery, and salvage surgery. In solving these problems, the surgeon’s judgment, surgical experience, and surgical skills are especially important.