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Eur J Cardiothorac Surg 2008;34:708. doi:10.1016/j.ejcts.2008.06.011
Copyright © 2008, European Association for Cardio-thoracic Surgery. Published by Elsevier. All rights reserved.
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Letters to the Editor

Reply to Heyman and Van Schil

Marco Lucchi*, Alfredo Mussi

Division of Thoracic Surgery, Cardiac and Thoracic Department, University of Pisa, Pisa, Italy

Received 9 June 2008; accepted 10 June 2008.

* Corresponding author. Address: Division of Thoracic Surgery, Cardiac and Thoracic Department, University of Pisa, Via Paradisa 2, Pisa 56124, Italy. Tel.: +39 050 995226; fax: +39 050 995226. (Email: m.lucchi{at}med.unipi.it).

Key Words: Thymoma • Pleural • Recurrence

We thank Heyman and Van Schil for their interest and added experience on the issue of surgical treatment of pleural recurrence of thymoma [1,2]. Such recurrences are rare and very rarely appear isolated. However with a strict follow-up by means of CT we are finding some cases [3,4].

When they are isolated often the pleural effusion is absent and, after a careful exploration of the pleural cavity, a single implant can be safely removed. Very recently we found a case of bilateral pleural implants 5 year from the resection of an invasive thymoma; we decided to treat them with staged procedures. On the left we removed multiple implants and added hyperthermic intrapleural chemotherapy, on the right we removed a single implant by VATS.

Furthermore, hyperthermic intrapleural chemotherapy is also feasible by a VATS approach, as already described [5] and personally performed for a huge stage IVA thymoma in a neoadjuvant setting.

As emphasized [1] it is unlikely that a randomized study will ever be performed to determine optimal treatment of pleural recurrences of thymoma; as a consequence every personal, even minimum experience is welcome in order to understand and improve the treatment of such rare situations. Limiting surgical trauma in patients with recurrent thymic disease and myasthenia, who might undergo iterative resections for subsequent pleural recurrences, is an important end-point and the efforts of Heyman and Van Schil of performing a pleural implant resection by VATS should be congratulated.

References

  1. Heyman S, Van Schil P. Surgical treatment of pleural recurrence from thymoma. Eur J Cardiothorac Surg 2008;34:707-708.[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(1):299-301.[Abstract/Free Full Text]
  3. Lucchi M, Basolo F, Mussi A. Surgical treatment of pleural recurrence from thymoma. Eur J Cardiothorac Surg 2008;33(4):707-711.[Abstract/Free Full Text]
  4. Ruffini E, Mancuso M, Oliaro A, Casadio C, Cavallo A, Cianci R, Filosso PL, Molinatti M, Porrello C, Cappello N, Maggi G. Recurrence of thymoma: analysis of clinicopathologic features, treatment, and outcome. J Thorac Cardiovasc Surg 1997;113(1):55-63.[Abstract/Free Full Text]
  5. Shigemura N, Akashi A, Nakagiri T, Hazama K, Ohta M, Matsuda H. Pleural perfusion thermo-chemotherapy under VATS: a new less invasive modality for advanced lung cancer with pleural spread. Ann Thorac Surg 2004;77(3):1016-1021.[Abstract/Free Full Text]




This Article
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Right arrow Pleura

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