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De Iaco et al. Mini-invasive Surg 2020;4:63 Mini-invasive Surgery
DOI: 10.20517/2574-1225.2020.37

Review Open Access

Standardized definitions and concepts of radicality
during minimally invasive thymoma resection

Giulia De Iaco , Debora Brascia , Alessandro Geronimo, Doroty Sampietro, Angela Fiorella, Marcella
#
#
Schiavone, Teodora Panza, Francesca Signore, Giuseppe Marulli
Thoracic Surgery Unit, Department of Organ Transplantation and Emergency, University Hospital of Bari, Bari 70124, Italy.
# These two authors equally contributed to the writing of the work.

Correspondence to: Prof. Giuseppe Marulli, Thoracic Surgery Unit, Department of Organ Transplantation and Emergency,
University Hospital of Bari, Piazza Giulio Cesare 11, Bari 70124, Italy. E-mail: giuseppe.marulli@uniba.it; beppemarulli@libero.it

How to cite this article: De Iaco G, Brascia D, Geronimo A, Sampietro D, Fiorella A, Schiavone M, Panza T, Signore F, Marulli G.
Standardized definitions and concepts of radicality during minimally invasive thymoma resection. Mini-invasive Surg 2020;4:63.
http://dx.doi.org/10.20517/2574-1225.2020.37

Received: 16 Apr 2020 First Decision: 15 Jun 2020 Revised: 11 Jul 2020 Accepted: 18 Aug 2020 Published: 17 Sep 2020
Academic Editor: Piergiorgio Solli Copy Editor: Cai-Hong Wang Production Editor: Jing Yu

Abstract
Radical thymectomy is the gold standard treatment for thymoma; in particular, completeness of surgical resection
of a well-encapsulated thymoma and adequate margins are considered the most important prognostic factors.
According to the International Thymic Malignancy Interest Group instructions, in fact, the thymus should be
resected en bloc with its upper cervical poles and the surrounding mediastinal fat and through a no-touch surgical
technique. For years, the open approaches have been considered the gold standard treatment for thymic masses,
because of technical advantages and proved good oncological results. When applied to properly chosen patients
on the basis of the tumor stage, dimension, and histology, minimally invasive approaches could be as effective
as open ones in terms of long-term outcomes. To accomplish a minimally invasive thymoma resection, several
minimally invasive techniques (transcervical, subxiphoid, thoracoscopic, and robotic) have been described, each
presenting advantages and drawbacks. Moreover, when dealing with early stage neoplasms, many authors have
proposed to perform the thymomectomy alone, not involving the rest of the thymic gland, but evidence is still
imprecise and vague, and some studies have described a higher rate of local recurrence when using this technique.
Finally, many studies suggest that surgeons with expertise in minimally invasive lymphadenectomy for lung
cancer may easily endorse the idea of nodal dissection, to be performed at least in advanced thymomas involving
neighboring structures, large masses, and thymic carcinomas.

Keywords: Thymoma, thymectomy, minimally invasive techniques, radicality

© The Author(s) 2020. Open Access This article is licensed under a Creative Commons Attribution 4.0
International License (https://creativecommons.org/licenses/by/4.0/), which permits unrestricted use,
sharing, adaptation, distribution and reproduction in any medium or format, for any purpose, even commercially, as long
as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license,
and indicate if changes were made.

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