THYMOMA AND OUR SURGICAL RESULTS

Year 2020, Volume: 21 Issue: 4, 312 - 318, 14.10.2020

Suphi Aydın Koray Aydoğdu Leyla Acar Erkmen Gülhan Göktürk Fındık Ülkü Yazıcı Funda Demirağ İrfan Taştepe Sadi Kaya Ahmet Dumanlı

https://doi.org/10.18229/kocatepetip.629956

Abstract

OBJECTIVE: This study aims to retrospectively evaluate the survival criteria of 39 patients operated on for thymoma concerning age, sex, symptoms, smoking history, operation type, presence of MG, thymic pathology, length of hospital stay, the diameter of the mass, stage, RT and/or KT, and complications according to WHO classification and Masaoka staging.
MATERIAL AND METHODS: In this study, 50 patients who were operated on for thymoma in Atatürk Chest Diseases and Thoracic Surgery Education and Research Hospital between 2000 and 2010 were examined. 11 patients were excluded from the study because 3 patients refused postoperative treatment; 3 patients discontinued treatment, and the information about 5 patients was not available. As a result, 39 patients (25 males, 14 females) were included in the study. Complete resection was performed in 35 cases, and incomplete resection was performed in 2 cases. Besides, surgical diagnostic procedures were performed in 2 cases. Medial sternotomy was performed in 30 cases (76.9%), right thoracotomy in 6 cases (15.4%) and left thoracotomy in 3 cases (7.7%).
RESULTS: The patients’ ages ranged from 23 to 88 years. The mean age of the patients was 51.3 ± 15.3 (years). 25 (64.1%) of them were male and 14 (35.9%) of them were female. Postoperative complications occurred in 6 patients (15.4%) (1 patient had hoarseness due to recurrent nerve injury; 4 patients had atelectasis, and 1 patient had pneumothorax on the 6th postoperative day). One patient died due to intraoperative myocardial infarction. In our WHO histopathological classification cases, 8 (20.5%) type A, 5 (12.8%) type AB, 4 (10.3%) type B1, 1 (2.6%) type B1 / B2, 9 (23.1%) type B2, 4 (10.3%) type B2 / B3, 5 (12.8%) B3, 3 (7.7%) C were determined respectively. 9 (23.1%) type B2 and 8 (20%, 5) type A were the most common groups. Masaoka clinical stage was 11 (28.2%) stage 1, 10 (25.6%) stage 2A, 8 (20.5%) stage 2B, 8 (20.5%) stage 3, 2 (5.1%) stage 4. The 3-year, 5-year and 8-year survival rates were as follows; 96.5%, 75.1%and 67.6% of the patients. The mean life expectancy was 102.8months. Crude mortality rate was 20.5% (8/39). In our study,according to Masaoka staging, type 1 and 2A were the mostcommon while type B2 and type A were the most common according to WHO classification. The 3, 5 and 8-year survival rates of the patients were found as follows; 96.5%, 75% and 67.6%
CONCLUSIONS: The best results in thymoma are obtained through total surgical resection. There was no positive effect of incomplete resection on survival. Prognosis is related to stage, histology and whether the surgical resection is complete. Prognosis is very promising in early-stage tumors.

Keywords

Thymomas, Surgery, Staging

TİMOMA VE CERRAHİ SONUÇLARIMIZ

Abstract

AMAÇ:Bu çalışmanın amacı timoma nedeniyle opere edilen 39 hastanın retrospektif olarak, cinsiyet, yaş, sigara içme hikayesi, semptom, operasyon şekli, Myastenia Graves (MG) varlığı, timik patoloji, hastanede kalış süresi, kitlenin çapı, evre, Radyoterapi (RT) ve/veya kemoterapi (KT) alma durumu, komplikasyon, WHO sınıflamasına ve Masaoka evrelemelerine göre sağkalım sürelerini incelemektir.
GEREÇ VE YÖNTEM: Bu çalışmada Atatürk Göğüs Hastalıkları ve Göğüs Cerrahisi Eğitim ve Araştırma Hastanesi 2000-2010 yılları arasında timoma nedeniyle opere edilen 50 hasta incelendi. 3 hastanın postoperatif tedaviyi red etmesi, 3 hastanın tedaviyi yarım bırakması, 5 hastanın da bilgilerine ulaşılamaması nedeniyle çalışmadan çıkarıldı ve 39 (25 erkek, 14 bayan) hasta çalışmaya dahil edildi. Olguların 35’ine komplet rezeksiyon, 2 olguya inkomplet rezeksiyon uygulandı, 2 olguda ise sadece cerrahi ile tanısal işlem yapılabildi. 30 olguya (%76,9) median sternotomi yapılırken, 6 olguya (%15,4) sağ torakotomi, 3 olguya (%7,7) ise sol torakotomi yapıldı.
BULGULAR: Hastaların yaşları 23 ile 88 arasında, ortalaması 51,3±15,3 (yıl) idi. 25’i (%64,1) erkek, 14’ü (%35,9) kadındı. Olguların 6’sında (%15,4) cerrahi sonrasında komplikasyon gelişti (1 hastada rekürren sinir yaralanmasına bağlı ses kısıklığı, 4 hastada atalektazi, 1 hastada postoperatif 6. günde pnömotoraks meydana geldi). 1 hasta intraoperatif myokard enfarktüsü sonucu exitus oldu. WHO histopatolojik sınıflama olgularımızda sırasıyla: 8 (%20,5) tip A, 5 (%12,8) tip AB, 4 (%10,3) tip B1, 1 (%2,6) tip B1/B2, 9 (%23,1) tip B2, 4 (%10,3) tip B2/B3, 5 (%12,8) B3, 3 (%7,7) C olup, 9 (%23,1) tip B2 ve 8 (%20,5) tip A en sık rastlanan gruptu. Masaoka klinik evre ise 11 (%28,2) evre 1, 10 (%25,6) evre 2A, 8 (%20,5) evre 2B, 8 (%20,5) evre 3, 2 (%5,1) evre 4 şeklindedir. Olguların 3 yıllık, 5 yıllık ve 8 yıllık sağkalım hızları sırasıyla; %96,5, %75,1 ve %67,6 olarak saptandı. Ortalama yaşam süresi ise 102,8 ay olarak tespit edildi. Kaba ölüm oranı ise %20,5 (8/39) olarak saptandı.
SONUÇ: Timomada öncelikli olarak komplet cerrahi rezeksiyon yapılmalıdır. İnkomplet rezeksiyonun sağkalım üzerinde olumlu bir etkisi bulunmamaktadır. Prognozda evresi, histolojik tipi ve cerrahinin şekli belirleyicidir. Erken evre tümörlerde prognoz oldukça iyidir. Çalışmamızda Masaoka evrelemesine göre en sık evre 1 ve 2A, WHO sınıflamasına göre de en sık tip B2 ve tip A tespit edildi. Olguların 3, 5 ve 8 yıllık sağkalım hızları sırasıyla; %96,5, %75 ve %67,6 olarak bulundu.

Keywords

Timoma, cerrahi, evreleme.

References

• 1. Nishino M, Ashiku SK, Kocher ON, et al. The thymus: a comprehensive review. Radiographics 2006;26:335-48.
• 2. Miller JF. Events that led to the discovery of T-cell development and function--a personal recollection. Tissue Antigens 2004;63:509-17.
• 3. Shields TW, The thymus. In: Shields TW, Lo Cicero III J, Ponn RB, Rusch VW, editors. General Thoracic Surgery. 7 th ed.Philadelphia: Lippincott Williams Wilkins,2009;2359-67.
• 4. Lewis JE, Wick MR, Scheithauer BW, et al.Thymoma. A clinicopathologic review. Cancer 1987;60:2727-43.
• 5. López-Cano M, Ponseti-Bosch JM, Espin-Basany E, et al. Clinical and pathologic predictors of outcome in thymoma-associated myasthenia gravis. Ann Thorac Surg 2003;76:1643-9.
• 6. Marx A, Müller-Hermelink HK, Ströbel P. The role of thymomas in the development of myasthenia gravis. Ann NY Acad Sci 2003;998:223-6.
• 7. Chen G, Marx A, Wen-Hu C. et al. New WHO histologic classification predicts prognosis of thymic epithelial tumors, a clinicopathologic study of 200 thymoma cases from China. Cancer 2002;95:420-429.
• 8. Okumura M, Ohta M, Tateyama H. et al. The World Health Organization histologic classification system reflects the oncologic behavior of thymoma, a clinical study of 273 patients. Cancer 2002; 94: 624-632.
• 9. Blok MI. Thymic tumors. In: Pearson FG, Cooper JD, Deslauriers J, Ginsberg RJ, Hierbert CA, Patterson GA, Urschel HC, eds. Thoracic Surgery. Philadelphia: Churchill Livingston. 2002: 1682-1710.
• 10. Rea F, Marulli G, Girardi R. et al. Long term survival and prognostic factors in thymic epithelial tumours. Eur J Cardiothorac Surg 2004; 26:412-418.
• 11. Kondo K, Yoshizawa K, Tsuyuguchi M. et al. WHO histologic classification is a prognostic indicator in thymoma . Ann Thor Surg 2004;77:183-8.
• 12. Kim DJ, Yang WI, Choi SS et al. Prognostic and clinical relevance of the world health organization schema for the classification of thymic epithelial tumors, a clinicopathologic study of 108 patients and literature review. Chest 2005;127: 755-761.
• 13. Chalabreysse L, Roy P, Cordier J. et al. Correlation of the WHO schema for the classification of thymic epithelial neoplasms with prognosis, a retrospective study of 90 tumors. Am J Surg Pathol 2002;26(12):1605-1611.
• 14. Haniuda M, Morimoto M, Nishimura H, et al. Adjuvant radiotherapy after complete resection of thymoma. Ann Thorac Surg 1992;54:311-5.
• 15. Wilkins EW, Grillo HC, Scannell JG, et al. Role of staging in prognosis and management of thymoma. Ann Thorac Surg 199;151:888-92.
• 16. Verley JM, Hollmann KH. Thymoma. A comparative study of clinical stages, histologic features, and survival in 200 cases. Cancer 1985;55:1074-86.
• 17. Monden Y, Nakahara K, Iioka S, et al. Recurrence of thymoma: Clinicopathological features, therapy and prognosis. Ann Thorac Surg. 1985;39:165-9.
• 18. Masaoka A, Monden Y, Nakahara K, Tanioka T. Follow-up study of thymomas with special reference to their clinical stages. Cancer 1981;48:2485-92.
• 19. Maggi G, Casadio C, Cavallo A, et al. Results of 241 operated cases. Ann Thorac Surg 1991;51:152-6.
• 20. Shamji F, Pearson FG, Todd TRJ, et al. Result of surgical treatment for thymoma. J Thorac Cardiovasc Surg 1984; 87:43-7.
• 21. Regnard JF, Magdeleinat P, Dromer C, et al. Prognostic factors and long-term results after thymoma resection: a series of 307 patients. J Thorac Cardiovasc Surg 1996;112:376-84.
• 22. Braitman H, Herrmann C, Mulder DG. Surgery for thymic tumors. Arch Surg 1971;103:14-6.
• 23. Fuentes P, Leude E, Ruiz C, et al. Treatment of thymoma: A report of 67 cases. Eur J Cardioc Thorac Surg 1992;6: 180-8.
• 24. Yagi K, Hirata T, Fukuse T, et al. Surgical treatment for invasive thymoma, especially when the superior vena cava is invaved. Ann Thorac Surg 1996;61:521-4.
• 25. Blumberg D, Port JL, Weksler B et al. Thymoma: A multivariate analysis of factors predicting survival Ann Thorac Surg 1995:60:908-914.
• 26. Cohen DJ, Graeber GM, Deshong SJL., et al. Management of patients with malignant thymoma. J Thorac Cardiovasc Surg 1984;87:301-7.
• 27. Nakahara K, Ohno K, Hashimoto J, et al. Thymoma: result with complete resection and adjuvant postoperative irradiation in 141 consecutive patients. J Thorac Cardiovasc Surg 1988;95:1041-7.
• 28. Pescarmona E, Rendina EA, Venuta F, et al. Analysis of prognostic factors and clinicopathological staging of thymoma. Ann Thorac Surg 1990;50:534-8.
• 29. Marino M, Müller-Hermelink HK. Thymoma and thymic carcinoma: relation of thymoma epithelial cells to cortical and medullary differentiation of thymus. Virchows Arch 1985;407:119-49.
• 30. Ricci C, Rendina E, Pescarmona E. Correlation between histological type, clinical behavior and prognosis in thymoma. Thorax 1989;44:455-60.
• 31. Venuta F, Rendina EA, Pescarmona EO, et al. Multimodality treatment of thymoma: a prospective study. Ann Thorac Surg 1997;64:1585-92.
• 32. Fornasiero A, Daniele O, Ghiotto C, et al. Chemotherapy for invasive thymoma. A 13 year experience. Cancer 1991; 68:30-3.