علاج سرطان الغدة الصعترية عندما يكون الاستئصال الكامل ممكناً من البداية (مرحلة ماساوكا-كوغا I–III / مرحلة TNM I–IIIA)

References

DOI: 10.1093/annonc/mdv277

Treatment algorithm for resectable thymic tumour (Masaoka-Koga stage I–III, TNM stage I–IIIA).

If complete resection is deemed to be achievable upfront, as it is the case in Masaoka-Koga stage I/II and some stage III tumours (classified as stage I, II, IIIA/T3 in the IASLC/ITMIG TNM proposed system), surgery represents the first step of the treatment [IV, A], possibly followed by postoperative radiotherapy and, less frequently, chemotherapy (Table 5).

Upfront surgery [IV, A]. The standard approach is median sternotomy [IV, A], which allows the wide opening of the mediastinum and both pleural cavities, followed by evaluation of macroscopic capsular invasion, infiltration of perithymic and mediastinal fat, peritumoural and pleural adherences and involvement of surrounding structures.

Generally, complete thymectomy including the tumour, the residual thymus gland and perithymic fat is preferred because local recurrences have been observed after partial thymectomy when part of the thymus gland is left behind [IV, B].

If the tumour is widely invasive (stage III/IV), en bloc removal of all affected structures, including lung parenchyma (usually through limited resection), pericardium, great vessels, nerves and pleural implants, should be carried out [IV, A].

Systematic lymphadenectomy (N1 + N2) is strongly recommended in case of thymic carcinoma due to the high rate of lymphatic spread (20% versus 3% in thymomas) [V, B].