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Eur J Cardiothorac Surg 2008;34:707-708. doi:10.1016/j.ejcts.2008.06.012
Copyright © 2008, European Association for Cardio-thoracic Surgery. Published by Elsevier. All rights reserved.
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Letters to the Editor

Surgery for isolated pleural recurrence from thymoma

Stijn Heyman*, Paul Van Schil

Department of Thoracic and Vascular Surgery, Antwerp University Hospital, Wilrijkstraat 10, 2650 Edegem, Antwerp, Belgium

Received 26 May 2008; accepted 10 June 2008.

* Corresponding author. Tel.: +32 478 40 95 02. (Email: stijn_heyman{at}hotmail.com).

Key Words: Thymoma • Pleural • Recurrence

We read with great interest the article of Lucchi et al. [1] on surgical treatment of pleural recurrence of thymoma. As such recurrences are rare we want to add an additional case we recently encountered [2]. Recurrent myasthenia gravis was observed in a 43-year-old patient 3 years after radical thymectomy for which a partial pericardial resection had been necessary to obtain a complete resection. An isolated pleural recurrence was discovered above the left diaphragm which could be removed by video-assisted thoracic surgery (VATS). Almost complete regression of myasthenic symptoms was observed 6 months later.

Lucchi et al. [1] thoroughly reviewed the literature with a focus on incidence, diagnosis, treatment and prognosis. Different treatment modalities of recurrent thymoma exist. As isolated pleural implants are exceptional, it is unlikely that a randomized study will ever be performed to determine optimal treatment. Isolated pleural implants with or without mediastinal relapse should be considered as stage IVA thymoma [3,4]. As resected patients are the only long-term survivors, Lucchi et al. [1] propose surgical treatment if this is feasible. As adjuvant therapy corticosteroids, low-dose hemithorax radiotherapy or intraoperative hyperthermic intrathoracic perfusion chemotherapy may be added. Systemic chemotherapy or octreotide analogues may be the treatment of choice in younger patients.

Lucchi et al. also propose the hypothesis of seeding from the primary tumor due to manipulation, especially when the mediastinal pleura has been opened. So, every effort should be made to obtain free resection margins during the initial procedure.

Our case demonstrates that resection of a localized pleural recurrence is possible by a VATS approach in a suitable case, limiting surgical trauma in patients with recurrent myasthenia.

References

  1. Lucchi M, Fulvio B, Mussi A. Surgical treatment of pleural recurrence from thymoma. Eur J Cardiothorac Surg 2008;33:707-711.[Abstract/Free Full Text]
  2. Heyman S, De Raeve H, Mercelis R, de Pooter C, Van Schil P. Recurrent myasthenia gravis due to a pleural implant 3 years after radical thymectomy. Ann Thorac Surg 2008;86:299-301.[Abstract/Free Full Text]
  3. Venuta F, Rendina EA, Longo F, De Giacomo T, Anile M, Mercadante E, Venturi L, Osti MF, Francioni F, Coloni GF. Long-term outcome after multimodality treatment for stage III thymic tumors. Ann Thorac Surg 2003;76:1866-1872.[Abstract/Free Full Text]
  4. Lucchi M, Ambrogi MC, Duranti L, Basolo F, Fontanini G, Angeletti CA, Mussi A. Advanced stage thymomas and thymic carcinomas: results of multimodality treatments. Ann Thorac Surg 2005;79:1840-1844.[Abstract/Free Full Text]



This article has been cited by other articles:


Home page
 Eur. J. Cardiothorac. Surg.Home page
M. Lucchi and A. Mussi
Reply to Heyman and Van Schil
Eur. J. Cardiothorac. Surg., September 1, 2008; 34(3): 708 - 708.
[Full Text] [PDF]

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Right arrow Mediastinum
Right arrow Pleura

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