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The Journal of Thoracic and Cardiovascular Surgery, Vol 95, 1041-1047, Copyright © 1988 by The American Association for Thoracic Surgery and The Western Thoracic Surgical Association
K Nakahara, K Ohno, J Hashimoto, H Maeda, S Miyoshi, M Sakurai, Y Monden and Y Kawashima
A series of 141 patients with thymoma was studied with regard to the way in
which complete resection followed by postoperative radiation therapy
influenced prognosis according to the stage and histologic type of thymoma.
Postoperative radiation therapy (30 Gy in 3 weeks to 50 Gy in 6 weeks) was
performed in 73.1% of the patients. Thirty-five of 48 patients with thymoma
invading the surrounding tissues (stage III) underwent complete resection,
with survival rates of 100% at 5 years and 94.7% at 10 and 15 years. The
prognosis in these patients was comparable with those in 45 patients with
no invasion (stage I) and in 33 patients with capsular invasion (stage
III), all of whom underwent complete resection. Complete resection was done
in 18 of 26 patients with epithelial cell thymoma, and there were no deaths
by tumor until 15 years after the operation. There were no statistically
significant differences in the survival rates of patients undergoing
complete resection according to cell type (33 of 36 patients with
lymphocyte predominant type and 61 of 77 patients with mixed cell type).
The survival rate in six patients with epithelial cell type who underwent
subtotal resection was not significantly different from that of 12 patients
who underwent biopsy alone. Our findings indicate that complete resection
of thymoma followed by postoperative radiation therapy results in a
"benign" postoperative course, regardless of the stage and histologic type.
Therefore, an aggressive surgical approach, such as resection of the
superior vena caval system followed by reconstruction with a ringed
polytetrafluoroethylene graft and/or complete pleuropneumonectomy, is
justified for advanced thymoma, although the long-term results of such
extended operations are still unclear.
ARTICLES
Thymoma: results with complete resection and adjuvant postoperative irradiation in 141 consecutive patients
First Department of Surgery, Osaka University Medical School, Japan.
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