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Front Oncol. 2014 Jan 14;3:332. doi: 10.3389/fonc.2013.00332. eCollection 2014.

Surgical Approaches for Stage IVA Thymic Epithelial Tumors.

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  • 1The Daniel and Gloria Blumenthal Cancer Center , Paramus, NJ , USA ; The Division of Thoracic Surgery, Department of Surgery, The Valley Hospital, Valley Health System , Ridgewood, NJ , USA.


Thymic epithelial tumors (TET) are rare mediastinal neoplasms that can metastasize to the pleural space (stage IVA). Complete surgical resection remains the backbone of therapy for patients with early stage TET, however, the role of surgery in the management of patients with stage IVA disease is not fully defined. Published reports in this regard are mainly small, retrospective, and uncontrolled, with unclear inclusion criteria. Surgical options to manage pleural disease include metastasectomy, extrapleural pneumonectomy, and metastasectomy/pleurectomy combined with heated intrapleural chemotherapy. The choice of the most appropriate surgical strategy needs to be individualized according to the quantity and location of disease, the patient's overall condition, as well as operator and institutional expertise. In the majority of cases, metastasectomy of pleural implants will be sufficient to achieve a complete resection. The available literature suggests that in selected patients with stage IVA TET, delivery of neoadjuvant chemotherapy followed by complete resection is a viable treatment option that can be associated with long-term survival.


extrapleural pneumonectomy; hyperthermic intrathoracic chemotherapy; metastasectomy; neoadjuvant therapy; stage IVA thymoma; surgery

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