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Ann Thorac Surg. 2012 Jul;94(1):247-54; discussion 254. doi: 10.1016/j.athoracsur.2012.02.092. Epub 2012 May 26.

The role of surgical management in recurrent thymic tumors.

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1
Division of General Thoracic Surgery, Mayo Clinic, Rochester, Minnesota 55905, USA.

Abstract

BACKGROUND:

There are few data on outcomes after surgical treatment for recurrent thymic tumors. The aim of this study is to analyze and compare long-term outcomes of treatments for recurrent thymic tumors.

METHODS:

Between January 1956 and December 2009, 344 thymic tumors were surgically resected (309 thymomas, 22 thymic carcinomas, 12 thymic carcinoids, and 1 thymolipoma). There were 48 recurrences (13.9%): 30 thymomas, 9 thymic carcinomas, and 9 thymic carcinoids. There were 27 men and 21 women with a median age of 51 years (range, 27 to 83). Retrospective chart review was performed. Relevant factors for recurrence as well as survival and progression-free interval were analyzed.

RESULTS:

The median follow-up interval from the initial operation was 83 months (range, 9 to 515). Recurrence adversely affected overall survival in surgically resected thymic tumors (p = 0.0014). In multivariate analysis, the initial Masaoka stage, incomplete resection, and World Health Organization histology were significant risk factors for recurrence. In multivariate analysis, only surgical management was associated with prolonged survival p = 0.0038) and improved progression-free interval (p = 0.0378) in recurrent thymoma. Five-year survival after recurrent thymoma was 54%. For recurrent thymic carcinoma, surgery did not improve survival. For these patients, chemotherapy was associated with improved progression-free interval after recurrence (p = 0.0295). There were no 5-year survivors of recurrent thymic carcinoma.

CONCLUSIONS:

Our data suggest that surgical management is associated with better outcome and is the treatment of choice for recurrent thymoma. For recurrent thymic carcinoma, surgical management has a very limited role, and chemotherapy appears to be a more effective treatment modality.

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