Thymoma surgery: Difference between revisions

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(/* Relapse Treatment Algorithm{{Cite web | last = | first = | title = http://www.cancertreatmentreviews.com/article/S0305-7372(11)00249-0/abstract | url = http://www.cancertreatmentreviews.com/article/S0305-7372(11)00249-0/abstract | publisher = |...)
 
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==Overview==
[[Surgery]] is the mainstay of treatment of thymoma.
==Surgery==
*[[Surgery]] is the mainstay of treatment of thymoma.
*If the [[tumor]] is [[Gross examination|grossly]] [[Invasive (medical)|invasive]] and large, [[Neoadjuvant chemotherapy|preoperative (neoadjuvant) chemotherapy]] and/or [[Radiation therapy|radiotherapy]] may be used to decrease the size and improve [[Resection|resectability]], before [[surgery]] is attempted.
*When the [[tumor]] is at an early stage (Masaoka I through IIB), no further [[therapy]] is necessary.
*[[Malignant tumors]] may need additional treatment with [[radiotherapy]], or sometimes with [[chemotherapy]], such as [[cyclophosphamide]], [[doxorubicin]], and [[cisplatin]].<ref name="pmid10561285">{{cite journal |author=Thomas CR, Wright CD, Loehrer PJ |title=Thymoma: state of the art |journal=[[Journal of Clinical Oncology : Official Journal of the American Society of Clinical Oncology]] |volume=17 |issue=7 |pages=2280–9 |year=1999 |month=July |pmid=10561285 |doi= |url=http://www.jco.org/cgi/pmidlookup?view=long&pmid=10561285 |accessdate}}</ref>
*Complete [[resection]] may require [[resection]] of the adjacent structures, including [[pleura]], [[lungs]], [[pericardium]], [[phrenic nerves]], and sometimes major [[vascular]] structures.
*[[Pleural]] surfaces should be examined for [[metastasis]].
*There is no long term data to support minimally [[Invasive (medical)|invasive]] procedures.<ref>{{Cite web  | last =  | first = | title = https://www.nccn.org/store/login/login.aspx?ReturnURL=http://www.nccn.org/professionals/physician_gls/pdf/thymic.pdf | url = https://www.nccn.org/store/login/login.aspx?ReturnURL=http://www.nccn.org/professionals/physician_gls/pdf/thymic.pdf | publisher = | date = | accessdate = }}</ref>
*A full [[median sternotomy]] is the standard open approach.
*The [[mediastinum]] must be explored for [[cervical]] [[thymus]] extension.


==Overview==
====Primary Diagnosis Treatment Algorithm<ref name="www.cancertreatmentreviews.com">{{Cite web  | last =  | first =  | title = http://www.cancertreatmentreviews.com/article/S0305-7372(11)00249-0/abstract | url = http://www.cancertreatmentreviews.com/article/S0305-7372(11)00249-0/abstract | publisher =  | date =  | accessdate = }}</ref>====
<br>
{{familytree/start |summary=PE diagnosis Algorithm.}}
{{familytree | | | |,|-| A01 |-|-|-|-|-|-|-|.| |A01=Stage I }}
{{familytree | | | |!| | | | | | | | | | | |!| | | | | | }}
{{familytree | | | |!| | | | | | | | | | | |!| | | | | | }}
{{familytree | | C01 | | C02 |-|-|-|-|-|-|.|!| |C01=Diagnosis of thymoma |C02=Resectable }}
{{familytree | | | |!| | | |!| | | | | | |!|!| | | | | | }}
{{familytree | | | |!| | | |!| B01 |-|-|-| B02 |-|-|-|-| B03 |-|-| B04 | | | | | |B01=Chemotherapy single agent (ifosfamide) or combination (ADOC/CAPP) |B02=Surgical resection |B03=Incomplete resection |B04=Radio/chemo therapy }}
{{familytree | | | |!| | | |!| |!| | | | | |!| | | | | | }}
{{familytree | | | |!| | | |!| |!| | | | | |!| | | | | | }}
{{familytree | | | |!| | | |!| |!| | | | | |!| | | | | | }}
{{familytree | | | |!| | | |!| |!| | | | | |!| | | | | | }}
{{familytree | | | |`|-| E01 |-| E02 |-| E03 | |E01=Stage II/III/IV |E02=Unresectable |E03=Radiotherapy }}
{{familytree/end}}
<br>


==Surgery==
====Relapse Treatment Algorithm<ref name="www.cancertreatmentreviews.com">{{Cite web  | last =  | first = | title = http://www.cancertreatmentreviews.com/article/S0305-7372(11)00249-0/abstract | url = http://www.cancertreatmentreviews.com/article/S0305-7372(11)00249-0/abstract | publisher = | date = | accessdate = }}</ref>====
Surgery is the mainstay of treatment.If the tumor is apparently invasive and large, preoperative (neoadjuvant) chemotherapy and/or radiotherapy may be used to decrease the size and improve resectability, before surgery is attempted. When the tumor is an early stage (Masaoka I through IIB), no further therapy is necessary. Removal of the thymus in adults does not appear to induce a severe [[immune deficiency]]. In children, however, added care and scrupulous vaccination are necessary to protect from infections. Malignant tumors may need additional treatment with [[radiotherapy]], or sometimes with chemotherapy ([[cyclophosphamide]], [[doxorubicin]] and [[cisplatin]]).<ref name="pmid10561285">{{cite journal |author=Thomas CR, Wright CD, Loehrer PJ |title=Thymoma: state of the art |journal=[[Journal of Clinical Oncology : Official Journal of the American Society of Clinical Oncology]] |volume=17 |issue=7 |pages=2280–9 |year=1999 |month=July |pmid=10561285 |doi= |url=http://www.jco.org/cgi/pmidlookup?view=long&pmid=10561285 |accessdate}}</ref>
<br>
{{familytree/start |summary=Relapse}}
{{familytree | | | | | | | | A01 |A01=Relapse}}
{{familytree | | | | |,|-|-|-|^|-|-|-|-|.| | | }}
{{familytree | | | B01 | | | | | | |,| B02 |.| |B01=Resectable|B02=Unresectable}}
{{familytree | | | |!| | | | | | | |!| | | |!| | }}
{{familytree | | | |!| | | | | | | C02 | | C03 | | | |C02=Radiotherapy |C03=Corticosteroids/Octreotide }}
{{familytree | | | |!| | | | | | | |!| | | |!| | }}
{{familytree | | | C01 |-|-|-|-|-|-|^|-|-|-|'| | | |C01=Surgical resection }}
{{familytree | | | |!| | | | | | | | | | | | | | }}
{{familytree | | | D01 | | | | | | | | | | | | |D01=Incomplete resection}}
{{familytree | | | |!| | | | | | | | | | | | }}
{{familytree | | | E01 | | | | | | | | | | |E01=Radiotherapy}}
{{familytree | | | | | | | | | | | | | | | | | }}
{{familytree | | | | | | | | | | | | | | | | | }}
{{familytree/end}}


==References==
==References==
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Latest revision as of 19:23, 15 August 2019

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Amr Marawan, M.D. [2] Ahmad Al Maradni, M.D. [3]

Overview

Surgery is the mainstay of treatment of thymoma.

Surgery

Primary Diagnosis Treatment Algorithm[3]


 
 
 
 
 
 
Stage I
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Diagnosis of thymoma
 
Resectable
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Chemotherapy single agent (ifosfamide) or combination (ADOC/CAPP)
 
 
 
Surgical resection
 
 
 
 
Incomplete resection
 
 
Radio/chemo therapy
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Stage II/III/IV
 
Unresectable
 
Radiotherapy
 
 
 
 
 


Relapse Treatment Algorithm[3]


 
 
 
 
 
 
 
Relapse
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Resectable
 
 
 
 
 
 
 
 
Unresectable
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Radiotherapy
 
Corticosteroids/Octreotide
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Surgical resection
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Incomplete resection
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Radiotherapy
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 

References

  1. Thomas CR, Wright CD, Loehrer PJ (1999). "Thymoma: state of the art". Journal of Clinical Oncology : Official Journal of the American Society of Clinical Oncology. 17 (7): 2280–9. PMID 10561285. Text "accessdate" ignored (help); Unknown parameter |month= ignored (help)
  2. "https://www.nccn.org/store/login/login.aspx?ReturnURL=http://www.nccn.org/professionals/physician_gls/pdf/thymic.pdf" (PDF). External link in |title= (help)
  3. 3.0 3.1 "http://www.cancertreatmentreviews.com/article/S0305-7372(11)00249-0/abstract". External link in |title= (help)

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