Iterative Surgical Treatment for Repeated Recurrences After Complete Resection of Thymic Tumors

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• 作者：Alfonso Fiorelli ; MD ; PhD^a ; ^{alfonso.fiorelli@unina2.it} ; Antonio D'Andrilli ; MD ; PhD^c ; Camilla Vanni ; MD^b ; Roberto Cascone ; MD^a ; Marco Anile ; MD^c ; Daniele Diso ; MD^c ; Valentina Tassi ; MD^d ; ^e ; Jacopo Vannucci ; MD^d ; Nicola Serra ; PhD^f ; Francesco Puma ; MD^d ; Erino Angelo Rendina ; MD ; PhD^b ; Federico Venuta ; MD^c ; Mario Santini ; MD^a
• 刊名：The Annals of Thoracic Surgery
• 出版年：2017
• 出版时间：February 2017
• 年：2017
• 卷：103
• 期：2
• 页码：422-431
• 全文大小：931 K
• 卷排序：103

文摘

In this study, we evaluated if surgical treatment and iterative operations could confer a survival advantage for patients with recurrent or repeated recurrences of thymoma.MethodsBetween 1984 and 2014, 53 of 515 (10%) patients had recurrences after complete thymoma resection. Demographics, stage, treatment, and pathologic findings were statistically analyzed to identify survival prognostic factors.ResultsThirty-eight of 53 (72%) patients underwent resection of recurrent thymoma; 32 (84%) underwent complete resection. Fifteen (28%) patients did not undergo resection; 3 (20%) received chemotherapy alone, 10 (67%) received chemoradiotherapy, and 2 (13%) received supportive care. At univariate analysis, World Health Organization (WHO) AB + B1 histologic types (p < 0.0001), R0 resection (p < 0.0001), myasthenia gravis (MG) (p = 0.02), and adjuvant therapy after recurrence (p = 0.03) were significant prognostic factors. At multivariate analysis, complete resection (p = 0.0003) was the only significant prognostic factor. Among patients with repeated resections, those undergoing complete resection had better survival than did those undergoing incomplete resection or no operative procedure (p = 0.02). Seven patients are alive and free of disease, with a median survival of 115 months (70–161 months) and 149 months (61–201 months) from the first recurrence and from thymoma resection, respectively.ConclusionsComplete resection is a viable treatment option for selected patients with recurrent thymomas. In cases of technically resectable repeated recurrences, repeated operations should be considered.