title: Oncological outcomes of thoracoscopic thymectomy for the treatment of stages I-III thymomas.
abstract: OBJECTIVE
  Thoracoscopic thymectomy has gradually replaced conventional sternotomy for resection of thymoma; however, a thoracoscopic approach for thymoma remains controversial. We evaluated the oncological outcomes of thoracoscopic thymectomy for the treatment of stages I-III thymomas.
  
  
  METHODS
  Sixty-two patients who underwent thoracoscopic thymectomy for the treatment of thymoma were retrospectively reviewed between July 2005 and September 2011 at Jikei University Hospital. Surgical outcomes and pathological results between stages I+II and stage III were compared.
  
  
  RESULTS
  Twenty-nine patients had Masaoka stage I, 28 had stage II and 5 had stage III. Three stage III patients needed conversions to open surgery. Masaoka stage III comprised pathological type B3 in 3 patients and thymic carcinoma in 2. For all patients, the 5-year overall survival rate was 100%. Three recurrences, diagnosed as thymic carcinoma, were observed in the Masaoka stage II or III patients. The 5-year disease-free survival rate was 94.2% for all patients, 100% for Masaoka stage I, 96.1% for stage II and 37.5% (55 months) for stage III (P=0.002). The 5-year disease-free survival rate was 100% for the World Health Organization classification types A, AB and B1-3 and 0% for thymic carcinoma (P<0.0001). Significant differences were found in the 5-year disease-free survival stratified by the Masaoka stage or WHO classification, but not by surgical procedures.
  
  
  CONCLUSIONS
  Thoracoscopic thymectomy for Masaoka stages I and II thymomas presented acceptable oncological outcomes. Further investigation in a large series with longer follow-up is required. Masaoka stage III thymoma requires careful consideration of the approaches, including median sternotomy.
authors: Department of Surgery, Jikei University School of Medicine, Minatoku, Tokyo, Japan. mak@jikei.ac.jp
authors: Makoto
authors: M
authors: Odaka
authors: Tadashi
authors: T
authors: Akiba
authors: Shohei
authors: S
authors: Mori
authors: Hisatoshi
authors: H
authors: Asano
authors: Hideki
authors: H
authors: Marushima
authors: Makoto
authors: M
authors: Yamashita
authors: Noriki
authors: N
authors: Kamiya
authors: Toshiaki
authors: T
authors: Morikawa
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002277:Carcinoma / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D016009:Chi-Square Distribution; D018572:Disease-Free Survival; D005260:Female; D006785:Hospitals, University; D006801:Humans; D007564:Japan; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000601:surgery; D009367:Neoplasm Staging; D012086:Reoperation; D012189:Retrospective Studies; D012307:Risk Factors; D056346:Sternotomy; D013906:Thoracoscopy / Q000009:adverse effects / Q000401:mortality; D013934:Thymectomy / Q000009:adverse effects / Q000379:methods* / Q000401:mortality; D013945:Thymoma / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D013953:Thymus Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D013997:Time Factors; D016896:Treatment Outcome; D055815:Young Adult
keywords: Thoracoscopic; Thymectomy; Thymoma
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