Reoperation for recurrent thymoma: experience in seven patients and review of the literature

The authors analysed retrospectively seven patients who underwent reoperation for recurrent thymoma. Patients have been categorised according to the classification of thymic epithelial tumours proposed by Masaoka et al. (29). In addition, patients have been subgrouped according to pleural invasion as defined by Haniuda et al. (15). Thus three substages were proposed as follows: p0-no adhesion to the mediastinal pleura; p1-patients with fibrous adhesion to the mediastinal pleura without microscopic invasion; p2-patients with microscopic invasion into the mediastinal pleura. At the initial operation, two patients were in Stage I, four Stage II, and one in Stage III. All Stage I patients were classified as p1, and of the four patients in Stage II one was classified as p0 and three patients as p2. One Stage III patient was classified as p2. Disease-free survival ranged from two years and four months to 20 years and two months. All patients underwent reoperation without preoperative treatment. Recurrent disease was aggressively resected from the pleura in six patients, mediastinum in four patients, lung in three patients, and diaphragm in three patients. Two patients refused further postoperative treatment. Adjuvant radiotherapy was administered to five patients; chemotherapy was added to the postoperative treatment of three patients with more advanced recurrent disease. Five patients were alive, free from any detectable tumour recurrence, one year and nine months to five years and four months after reoperation. In two patients with exacerbation of myasthenia gravis, reoperation was followed by complete remission of myasthenic symptoms. One patient died of post-radiation pulmonary fibrosis 13 months after reoperation, and one patient died of disease two years and two months after the second operation. Our findings indicate that an aggressive surgical approach to recurrent thymoma is justified and can be followed by prolonged disease-free survival