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G. Fontanini
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P2.08 - Poster Session/ Thymoma, Mesothelioma and Other Thoracic Malignancies (ID 225)
- Event: WCLC 2015
- Type: Poster
- Track: Thymoma, Mesothelioma and Other Thoracic Malignancies
- Presentations: 1
- Moderators:
- Coordinates: 9/08/2015, 09:30 - 17:00, Exhibit Hall (Hall B+C)
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P2.08-034 - 'Nerve Sparing' Surgery for Invasive Thymomas (ID 985)
09:30 - 09:30 | Author(s): G. Fontanini
- Abstract
Background:
Masaoka-Koga stage and the radicality of the surgical resection are the most important prognostic factors for thymomas. Infiltration of the phrenic nerve interests 10-40 % of invasive thymomas (stage III and IVA). We report the clinical and oncological outcome of patients operated on for invasive thymoma by a intention-to-treat “nerve sparing” technique.
Methods:
In the period 1992-2012 we have applied the “nerve sparing” surgery in all patients with invasive thymoma, and without pre-operative evidence of phrenic nerve paralysis. In that period we have operated on 72 stage III e 33 stage IVA thymomas. Thirteen out of them had a preoperative radiological evidence of phrenic paralysis (5 stage III and 8 IVA) and they were preliminary excluded. In 30 patients phrenic nerve was partially or completely surrounded by the thymoma and they underwent an attempt of ‘’nerve sparing’’ surgery. In twenty six cases the resection of the thymoma with a phrenic sparing procedure was possible. All patients underwent subsequent adjuvant radiation (45-60 Gy).
Results:
Twelve male and 14 female have been treated, with a mean age of 56 years (range 26-83). At the hystological analysis there were: 1 Type A, 5 Type AB, 10 Type B1, 5 Type B2, 5 Type B3. Myasthenia gravis and red cell aplasia were associated in fifteen and one case, respectively. Despite the attempt of preserving the phrenic nerve, in five patients phrenic palsy was observed in the immediate postoperative period. Three of them showed a complete phrenic nerve recovery, while in the other 2 cases nerve paralysis was irreversible. Mean follow up was 96 months (DS ±73) with an mean overall survival of 89 months (DS ±68). The mean disease free interval was 81 months (DS ±71). Three patients (11,5%) had a pleural recurrence (2 stage IVA, 1 stage III) requiring further surgical resection. Two patients (7,7 %) died (1 of systemic metastases and 1 for other cause).
Conclusion:
Preserving the phrenic nerve in case of invasive thymomas is feasible and if associated to adjuvant radiotherapy may also allow to achieve good long term disease-free results. In reason of the excellent local control of disease it should be proposed mainly to patients with invasive thymoma and myasthenia gravis or with a poor pulmonary function.
