THYMOMA AND OUR SURGICAL RESULTS

Yıl 2020, , 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

Öz

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.

Anahtar Kelimeler

Thymomas, Surgery, Staging

TİMOMA VE CERRAHİ SONUÇLARIMIZ

Öz

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.

Anahtar Kelimeler

Timoma, cerrahi, evreleme.

Kaynakça

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