Thoracoscopic Resection of Thymic Carcinoma

Abstract

Introduction:

Thymic cancer is a very rare malignancy, especially in childhood. A review of the Surveillance, Epidemiology and End Results registry found only 23 cases of thymic cancer in patients under 20 years of age from 1973 to 2008. Patients treated after 1990 had a 10-year survival rate of 75%, and worse outcomes were noted in patients with metastatic disease and those who did not undergo surgical resection. ¹ Surgery offers the only potential for cure and has historically been performed via median sternotomy, first described in 1941. Minimally invasive resection techniques are novel and have not yet been adequately studied. ²

Materials and Methods:

This video demonstrates partial thoracoscopic thymectomy for a thymic carcinoma adjacent to the pulmonary artery. A previously healthy 15-year-old male initially presented with wheezing and was diagnosed with thymic carcinoma. He underwent three rounds of neoadjuvant chemotherapy with cisplatin, etoposide, and prednisolone. He was then referred to a pediatric surgery charitable organization (Peedh Parai International) for consideration of surgical resection during a medical mission trip to Manipal, India.

In the operating room, the patient was placed in a supine position with his left side elevated on a bolster to approximately 30 degrees. Three 5 mm ports were placed in the mid-axillary line at the 3rd, 5th, and 7th intercostal spaces. The tumor was visualized superior to the left atrium overlying the pulmonary artery. A plane was carefully dissected between the tumor and the pulmonary artery using hook electrocautery, and dissection was continued around the circumference of the tumor until resection was complete. The most inferior port incision was extended to allow removal of the tumor. A 24F chest tube was placed under thoracoscopic visualization, and the left lung was allowed to re-expand. The incisions were closed in layers with Vicryl and dressed with Dermabond skin adhesive.

Results:

The patient’s recovery was uncomplicated. His chest tube was removed on postoperative day 1, and he was discharged on postoperative day 2. He has since followed up with the local pediatric surgical team in India and is recovering well. He is currently undergoing adjuvant chemotherapy.

Conclusion:

Partial thoracoscopic thymectomy provides a safe and effective approach to surgical resection of thymic carcinoma. This minimally invasive technique allows for smaller incisions, faster recovery, and lower risk of infection compared to the median sternotomy approach.

Author disclosure statement:

There are no conflicts of interest. Authors have received and archived patient consent for video recording/publication in advance of video recording of the procedure.

Runtime of video:

3 mins 59 secs