title: Long-term outcome of pleuropneumonectomy for Masaoka stage IVa thymoma.
abstract: OBJECTIVE
  Because pleuropneumonectomy is associated with a high mortality rate, its indication for the treatment of Masaoka stage IVa thymoma is debated. We reviewed retrospectively our single-center experience in order to determine if the benefits warrant the risk of such procedure.
  
  
  METHODS
  Between 1970 and 2009, 17 patients (12 men and 5 women) with a mean age of 44 years (range, 25-62 years) underwent a pleuropneumonectomy for a Masaoka stage IVa thymoma in our institution. Eight patients had recurrent thymoma after a mean postoperative period of 47 ± 28 months, and nine patients presented de novo with stage IVa disease. A multimodality treatment including chemotherapy, radiotherapy, or both was performed in 14 (82%) patients.
  
  
  RESULTS
  Eight patients (47%) experienced a major postoperative complication, including four broncho-pleural fistulae (23%). There were no operative deaths and the 30-day mortality was 17.6% (3/17). But two patients died at 2 and 3 months, increasing the postoperative mortality to 29.4% (5/17). Complete resection was achieved in 11 (65%) patients. By univariate analysis, myasthenia gravis was the only risk factor for broncho-pleural fistulae. With a median survival of 76 months and median follow-up of 59 months (range, 1-262 months), 5-year and 10-year survivals were 60% and 30%, respectively. During follow-up, a recurrence occurred in two patients at 26 and 87 months, respectively, which was treated medically without success.
  
  
  CONCLUSIONS
  Pleuropneumonectomy for Masaoka stage IVa thymoma is associated with a high morbid-mortality rate. However, included in a multimodality strategy and in highly selected patients this procedure may provide good long-term survival.
authors.affiliation: Marie-Lannelongue Hospital, Le Plessis Robinson, Paris-Sud University, Orsay, France. d.fabre@ccml.fr
authors.forename: Dominique
authors.initials: D
authors.lastname: Fabre
authors.forename: Elie
authors.initials: E
authors.lastname: Fadel
authors.forename: Sacha
authors.initials: S
authors.lastname: Mussot
authors.forename: Olaf
authors.initials: O
authors.lastname: Mercier
authors.forename: Boriana
authors.initials: B
authors.lastname: Petkova
authors.forename: Benjamin
authors.initials: B
authors.lastname: Besse
authors.forename: James
authors.initials: J
authors.lastname: Huang
authors.forename: Philippe G
authors.initials: PG
authors.lastname: Dartevelle
mesh_terms: D000328:Adult; D000465:Algorithms; D001983:Bronchial Fistula / Q000209:etiology; D017024:Chemotherapy, Adjuvant; D004812:Epidemiologic Methods; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D010995:Pleural Diseases / Q000209:etiology; D011013:Pneumonectomy / Q000009:adverse effects / Q000379:methods*; D018714:Radiotherapy, Adjuvant; D012008:Recurrence; D016156:Respiratory Tract Fistula / Q000209:etiology; D013945:Thymoma / Q000473:pathology / Q000601:surgery* / Q000628:therapy; D013953:Thymus Neoplasms / Q000473:pathology / Q000601:surgery* / Q000628:therapy; D016896:Treatment Outcome