Ann Thorac Surg 1997;64:1598
© 1997 The Society of Thoracic Surgeons
Discussion
Discussion
See also page 1593.
DR ALEX G. LITTLE (Las Vegas, NV): Are there any lessons you think you could derive regarding the first operation? Are there any principles regarding the initial resection of thymoma that appear to have been violated that you would correct?
DR REGNARD: There was no obvious problem during the first resection, but we were very surprised to note that most recurrences occur in the intrathoracic cavity previously opened during the first surgical procedure. Two explanations could be suggested: pleural dissemination from a capsular disruption during the surgical procedure or synchronous microscopic pleural dissemination related to the tumor growth not seen during the first surgical procedure. As a result, we really think that en bloc resection of the thymoma with invaded adjacent structures and care during the dissection to avoid capsular disruption should be recommended.
DR HERBERT E. WARDEN (Morgantown, WV): I compliment you on your nice presentation, and want to underscore the aggressive approach you recommend.
My colleagues and I have had a modest experience with thymomas and fortunately have had relatively few recurrences. In part, this may be simple luck, but also it may be because, as you and the pioneers in this field have advocated, we applied aggressive surgery to these tumors, both primary and recurrent. The following anecdote supports this approach.
In 1969, we resected a large right-sided anterior tumor from a 24-year-old woman. The pathologist identified it as a "benign noninvasive thymoma." Ten years later the patient returned with pleural and parenchymal nodules. These were resected completely, but she returned 11 months later with another parenchymal lesion and diffuse hilar and mediastinal lymph adenopathy. A right lower lobectomy and extensive lymphadenectomy of the hilum and mediastinum were carried out. It is now 19 years since this third operation and 28 years since her first procedure, and she is well without any evidence of recurrence. Most interesting was the change in histology. The original tumor was described as a lymphocytic thymoma without invasion. The recurrences removed at the second operation revealed a larger proportion of epithelial cells than lymphocytes and the third set of specimens were almost entirely epithelial cells.
Related Article
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Results of Re-resection for Recurrent Thymomas
- Jean-François Regnard, Franck Zinzindohoue, Pierre Magdeleinat, Lionel Guibert, Lorenzo Spaggiari, and Philippe Levasseur
Ann. Thorac. Surg. 1997 64: 1593-1598.
[Abstract]
[Full Text]
