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Page 10 of 16 De Iaco et al. Mini-invasive Surg 2020;4:63 I http://dx.doi.org/10.20517/2574-1225.2020.37

Figure 7. Gross specimen after robotic-assisted thoracoscopic surgery thymomectomy performed for a small intracapsular thymoma
(yellow arrow)

Therefore, all published studies do not solve the doubts about which approach should be better among all
the available ones and, thus far, no prospective randomized trials have been performed to clear them. For
this reason, the choice should be done by the surgeons on the basis of both available evidence and surgeons’
personal skills and preferences.

RADICALITY: THYMOMECTOMY OR THYMECTOMY?
All guidelines and large retrospective review studies recommend the complete en bloc thymectomy as
the current gold standard in all resectable thymic lesions because of the risk of a multicentric thymoma
development, the occurrence of MG after the operation, and the prevention of the local recurrences [10,73-76] .
However, many authors have proposed the resection of the thymoma without the rest of the thymic gland
as a feasible and safe resection in early stage thymomas (Stages I and II) without MG [77-86] [Figure 7].

[87]
Fiorelli et al. recently published the best evidence about equivalence in terms of oncological outcomes of
thymomectomy and thymectomy in patients with early stage thymoma. They found ten papers, and most
of which showed no statistical differences in terms of local recurrence, while differences were described in
terms of surgical outcomes (operative time, blood loss, drainage duration, and hospital stay) in favor of the
thymomectomy.

Among these studies, the largest multicentric ones [80,81] were those with a proved higher rate of local
[80]
recurrence in the thymomectomy group than in the thymectomy one. Gu et al. , in their multicenter