General principles and quality control of minimally invasive surgery for thymic malignances_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

 GU Zhitao ,  FANG Wentao

Department of Thoracic Surgery, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, 200030, P.R.China;

Corresponding author：

FANG Wentao, Email: vwtfang12@shchest.org

Keywords：

Thymic malignance; minimally invasive surgery; video-assisted thoracoscopic surgery

DOI：

10.7507/1007-4848.201811015

Video：

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Minimally invasive surgery (MIS) is currently mainly used for the treatment of early thymic tumors. In recent years, minimally invasive thymic surgery has been rapidly promoted at home and abroad. However, because of the low incidence of thymic tumors, the unbalanced experience of doctors, there are still many issues worthy of discussion in MIS. Standard MIS must follow similar oncological and resection principles. This paper involves the definitions of minimally invasive thymic surgery and general principles that should be adhered to when performing MIS for thymic malignances.

Citation： GU Zhitao, FANG Wentao. General principles and quality control of minimally invasive surgery for thymic malignances. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2019, 26(1): 29-34. doi: 10.7507/1007-4848.201811015 Copy

1.	Fang W, Fu J, Wei Y, et al. Management of thymic tumors- consensus based on the Chinese Alliance for Research in Thymomas multi-institutional retrospective studies. J Thorac Dis, 2016, 8(4): 641-645.
2.	Yim AP, Kay RL, Ho JK. Video-assisted thoracoscopic thymectomy for myasthenia gravis. Chest, 1995, 108(5): 1440-1443.
3.	Zhang X, Gu Z, Fang W, et al. Minimally invasive surgery in thymic malignances: the new standard of care. J Thorac Dis, 2018, 10(Suppl 14): S1666-S1670.
4.	Gu ZT, Mao T, Chen WH, et al. Comparison of video-assisted thoracoscopic surgery and median sternotomy approaches for thymic tumor resections at a single institution. Surg Laparosc Endosc Percutan Tech, 2015, 25(1): 47-51.
5.	Rückert JC, Walter M, Müller JM. Pulmonary function after thoracoscopic thymectomy versus median sternotomy for myasthenia gravis. Ann Thorac Surg, 2000, 70(5): 1656-1661.
6.	Hess NR, Sarkaria IS, Pennathur A, et al. Minimally invasive versus open thymectomy: a systematic review of surgical techniques, patient demographics, and perioperative outcomes. Ann Cardiothorac Surg, 2016, 5(1): 1-9.
7.	Burt BM, Yao X, Shrager J, et al. Determinants of complete resection of thymoma by minimally invasive and open thymectomy: analysis of an international registry. J Thorac Oncol, 2017, 12(1): 129-136.
8.	Wang H, Gu Z, Ding J, et al. Perioperative outcomes and long-term survival in clinically early-stage thymic malignancies: video-assisted thoracoscopic thymectomy versus open approaches. J Thorac Dis, 2016, 8(4): 673-679.
9.	Agatsuma H, Yoshida K, Yoshino I, et al. Video-assisted thoracic surgery thymectomy versus sternotomy thymectomy in patients with thymoma. Ann Thorac Surg, 2017, 104(3): 1047-1053.
10.	Rückert JC, Ismail M, Swierzy M, et al. Thoracoscopic thymectomy with the da Vinci robotic system for myasthenia gravis. Ann N Y Acad Sci, 2008, 1132: 329-335.
11.	Detterbeck FC, Zeeshan A. Thymoma: current diagnosis and treatment. Chin Med J (Engl), 2013, 126(11): 2186-2191.
12.	Detterbeck FC, Stratton K, Giroux D, et al. The IASLC/ITMIG Thymic Epithelial Tumors Staging Project: proposal for an evidence-based stage classification system for the forthcoming (8th) edition of the TNM classification of malignant tumors. J Thorac Oncol, 2014, 9(9 Suppl 2): S65-S72.
13.	Agasthian T. Can invasive thymomas be resected by video-assisted thoracoscopic surgery? Asian Cardiovasc Thorac Ann, 2011, 19(3-4): 225-227.
14.	Friedant AJ, Handorf EA, Su S, et al. Minimally invasive versus open thymectomy for thymic malignancies: systematic review and meta-analysis. J Thorac Oncol, 2016, 11(1): 30-38.
15.	Tagawa T, Yamasaki N, Tsuchiya T, et al. Thoracoscopic versus transsternal resection for early stage thymoma: long-term outcomes. Surg Today, 2014, 44(12): 2275-2280.
16.	Zieliński M, Kuzdzał J, Szlubowski A, et al. Transcervical-subxiphoid-videothoracoscopic "maximal" thymectomy--operative technique and early results. Ann Thorac Surg, 2004, 78(2): 404-409.
17.	Onuki T, Ishikawa S, Iguchi K, et al. Limited thymectomy for stage Ⅰ or Ⅱ thymomas. Lung Cancer, 2010, 68(3): 460-465.
18.	Tseng YC, Hsieh CC, Huang HY, et al. Is thymectomy necessary in nonmyasthenic patients with early thymoma? J Thorac Oncol, 2013, 8(7): 952-958.
19.	Nakagawa K, Yokoi K, Nakajima J, et al. Is thymomectomy alone appropriate for stage Ⅰ (T1N0M0) thymoma? Results of a propensity-score analysis. Ann Thorac Surg, 2016, 101(2): 520-526.
20.	Gu Z, Fu J, Shen Y, et al. Thymectomy versus tumor resection for early-stage thymic malignancies: a Chinese Alliance for Research in Thymomas (ChART) retrospective database analysis. Zhongguo Fei Ai Za Zhi, 2016, 19(7): 459-464.
21.	Wang F, Pang L, Fu J, et al. Postoperative survival for patients with thymoma complicating myasthenia gravis-preliminary retrospective results of the ChART database. J Thorac Dis, 2016, 8(4): 711-717.
22.	Bhora FY, Chen DJ, Detterbeck FC, et al. The ITMIG/IASLC Thymic Epithelial Tumors Staging Project: a proposed lymph node map for thymic epithelial tumors in the forthcoming 8th edition of the TNM classification of malignant tumors. J Thorac Oncol, 2014, 9(9 Suppl 2): S88-S96.
23.	Kondo K, Monden Y. Lymphogenous and hematogenous metastasis of thymic epithelial tumors. Ann Thorac Surg, 2003, 76(6): 1859-1864.
24.	Weksler B, Holden A, Sullivan JL. Impact of positive nodal metastases in patients with thymic carcinoma and thymic neuroendocrine tumors. J Thorac Oncol, 2015, 10(11): 1642-1647.
25.	Weksler B, Pennathur A, Sullivan JL, et al. Resection of thymoma should include nodal sampling. J Thorac Cardiovasc Surg, 2015, 149(3): 737-742.
26.	Hwang Y, Park IK, Park S, et al. Lymph node dissection in thymic malignancies: implication of the ITMIG lymph node map, TNM stage classification, and recommendations. J Thorac Oncol, 2016, 11(1): 108-114.
27.	Gu Z, Wei Y, Fu J, et al. Lymph node metastases in thymic malignancies: a Chinese Alliance for Research in Thymomas retrospective database analysis. Interact Cardiovasc Thorac Surg, 2017, 25(3): 455-461.
28.	Fang W, Wang Y, Pang L, et al. Lymph node metastasis in thymic malignancies: A Chinese multicenter prospective observational study. J Thorac Cardiovasc Surg, 2018, 156(2): 824-833.
29.	Detterbeck FC, Moran C, Huang J, et al. Which way is up? Policies and procedures for surgeons and pathologists regarding resection specimens of thymic malignancy. Zhongguo Fei Ai Za Zhi, 2014, 17(2): 95-103.
30.	Özkan B, Toker A. Catastrophes during video-assisted thoracoscopic thymus surgery for myasthenia gravis. Interact Cardiovasc Thorac Surg, 2016, 23(3): 450-453.
31.	Toker A, Sonett J, Zielinski M, et al. Standard terms, definitions, and policies for minimally invasive resection of thymoma. J Thorac Oncol, 2011, 6(7 Suppl 3): S1739-S1742.

1. Fang W, Fu J, Wei Y, et al. Management of thymic tumors- consensus based on the Chinese Alliance for Research in Thymomas multi-institutional retrospective studies. J Thorac Dis, 2016, 8(4): 641-645.
2. Yim AP, Kay RL, Ho JK. Video-assisted thoracoscopic thymectomy for myasthenia gravis. Chest, 1995, 108(5): 1440-1443.
3. Zhang X, Gu Z, Fang W, et al. Minimally invasive surgery in thymic malignances: the new standard of care. J Thorac Dis, 2018, 10(Suppl 14): S1666-S1670.
4. Gu ZT, Mao T, Chen WH, et al. Comparison of video-assisted thoracoscopic surgery and median sternotomy approaches for thymic tumor resections at a single institution. Surg Laparosc Endosc Percutan Tech, 2015, 25(1): 47-51.
5. Rückert JC, Walter M, Müller JM. Pulmonary function after thoracoscopic thymectomy versus median sternotomy for myasthenia gravis. Ann Thorac Surg, 2000, 70(5): 1656-1661.
6. Hess NR, Sarkaria IS, Pennathur A, et al. Minimally invasive versus open thymectomy: a systematic review of surgical techniques, patient demographics, and perioperative outcomes. Ann Cardiothorac Surg, 2016, 5(1): 1-9.
7. Burt BM, Yao X, Shrager J, et al. Determinants of complete resection of thymoma by minimally invasive and open thymectomy: analysis of an international registry. J Thorac Oncol, 2017, 12(1): 129-136.
8. Wang H, Gu Z, Ding J, et al. Perioperative outcomes and long-term survival in clinically early-stage thymic malignancies: video-assisted thoracoscopic thymectomy versus open approaches. J Thorac Dis, 2016, 8(4): 673-679.
9. Agatsuma H, Yoshida K, Yoshino I, et al. Video-assisted thoracic surgery thymectomy versus sternotomy thymectomy in patients with thymoma. Ann Thorac Surg, 2017, 104(3): 1047-1053.
10. Rückert JC, Ismail M, Swierzy M, et al. Thoracoscopic thymectomy with the da Vinci robotic system for myasthenia gravis. Ann N Y Acad Sci, 2008, 1132: 329-335.
11. Detterbeck FC, Zeeshan A. Thymoma: current diagnosis and treatment. Chin Med J (Engl), 2013, 126(11): 2186-2191.
12. Detterbeck FC, Stratton K, Giroux D, et al. The IASLC/ITMIG Thymic Epithelial Tumors Staging Project: proposal for an evidence-based stage classification system for the forthcoming (8th) edition of the TNM classification of malignant tumors. J Thorac Oncol, 2014, 9(9 Suppl 2): S65-S72.
13. Agasthian T. Can invasive thymomas be resected by video-assisted thoracoscopic surgery? Asian Cardiovasc Thorac Ann, 2011, 19(3-4): 225-227.
14. Friedant AJ, Handorf EA, Su S, et al. Minimally invasive versus open thymectomy for thymic malignancies: systematic review and meta-analysis. J Thorac Oncol, 2016, 11(1): 30-38.
15. Tagawa T, Yamasaki N, Tsuchiya T, et al. Thoracoscopic versus transsternal resection for early stage thymoma: long-term outcomes. Surg Today, 2014, 44(12): 2275-2280.
16. Zieliński M, Kuzdzał J, Szlubowski A, et al. Transcervical-subxiphoid-videothoracoscopic "maximal" thymectomy--operative technique and early results. Ann Thorac Surg, 2004, 78(2): 404-409.
17. Onuki T, Ishikawa S, Iguchi K, et al. Limited thymectomy for stage Ⅰ or Ⅱ thymomas. Lung Cancer, 2010, 68(3): 460-465.
18. Tseng YC, Hsieh CC, Huang HY, et al. Is thymectomy necessary in nonmyasthenic patients with early thymoma? J Thorac Oncol, 2013, 8(7): 952-958.
19. Nakagawa K, Yokoi K, Nakajima J, et al. Is thymomectomy alone appropriate for stage Ⅰ (T1N0M0) thymoma? Results of a propensity-score analysis. Ann Thorac Surg, 2016, 101(2): 520-526.
20. Gu Z, Fu J, Shen Y, et al. Thymectomy versus tumor resection for early-stage thymic malignancies: a Chinese Alliance for Research in Thymomas (ChART) retrospective database analysis. Zhongguo Fei Ai Za Zhi, 2016, 19(7): 459-464.
21. Wang F, Pang L, Fu J, et al. Postoperative survival for patients with thymoma complicating myasthenia gravis-preliminary retrospective results of the ChART database. J Thorac Dis, 2016, 8(4): 711-717.
22. Bhora FY, Chen DJ, Detterbeck FC, et al. The ITMIG/IASLC Thymic Epithelial Tumors Staging Project: a proposed lymph node map for thymic epithelial tumors in the forthcoming 8th edition of the TNM classification of malignant tumors. J Thorac Oncol, 2014, 9(9 Suppl 2): S88-S96.
23. Kondo K, Monden Y. Lymphogenous and hematogenous metastasis of thymic epithelial tumors. Ann Thorac Surg, 2003, 76(6): 1859-1864.
24. Weksler B, Holden A, Sullivan JL. Impact of positive nodal metastases in patients with thymic carcinoma and thymic neuroendocrine tumors. J Thorac Oncol, 2015, 10(11): 1642-1647.
25. Weksler B, Pennathur A, Sullivan JL, et al. Resection of thymoma should include nodal sampling. J Thorac Cardiovasc Surg, 2015, 149(3): 737-742.
26. Hwang Y, Park IK, Park S, et al. Lymph node dissection in thymic malignancies: implication of the ITMIG lymph node map, TNM stage classification, and recommendations. J Thorac Oncol, 2016, 11(1): 108-114.
27. Gu Z, Wei Y, Fu J, et al. Lymph node metastases in thymic malignancies: a Chinese Alliance for Research in Thymomas retrospective database analysis. Interact Cardiovasc Thorac Surg, 2017, 25(3): 455-461.
28. Fang W, Wang Y, Pang L, et al. Lymph node metastasis in thymic malignancies: A Chinese multicenter prospective observational study. J Thorac Cardiovasc Surg, 2018, 156(2): 824-833.
29. Detterbeck FC, Moran C, Huang J, et al. Which way is up? Policies and procedures for surgeons and pathologists regarding resection specimens of thymic malignancy. Zhongguo Fei Ai Za Zhi, 2014, 17(2): 95-103.
30. Özkan B, Toker A. Catastrophes during video-assisted thoracoscopic thymus surgery for myasthenia gravis. Interact Cardiovasc Thorac Surg, 2016, 23(3): 450-453.
31. Toker A, Sonett J, Zielinski M, et al. Standard terms, definitions, and policies for minimally invasive resection of thymoma. J Thorac Oncol, 2011, 6(7 Suppl 3): S1739-S1742.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

General principles and quality control of minimally invasive surgery for thymic malignances

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