title: Extended thymectomy including lung-sparing pleurectomy for the treatment of thymic malignancies with pleural spread.
abstract: OBJECTIVE
  To investigate the outcome of extended thymectomy including lung-sparing pleurectomy (extended surgery) in primary clinically advanced Masaoka-Koga stage IVa thymic malignancies.
  
  
  METHODS
  Thirteen patients diagnosed with thymic malignancies at primary clinically Masaoka-Koga stage IVa were retrospectively analyzed between January 2000 and December 2012 at the Department of Thoracic Surgery, Dr. Horst Schmidt Klinik, Wiesbaden. Chi-square tests, Kaplan-Meier analyses, log-rank tests, and Cox regression analyses were used to estimate survival and determine prognosticators of survival.
  
  
  RESULTS
  World Health Organization (WHO) classification were type C (n = 6), type B3 (n = 5), and type AB (n = 2), respectively. Nine patients underwent extended surgery. Morbidity was observed in three patients (33%). Mortality occurred in one patient. Four patients (31%) were unresectable at the time of surgery and underwent chemoradiation. Despite the clinically staging, five patients had lymph node metastases and thus pathologic Masaoka-Koga stage IVb. Median survival (MS) for all patients was 49 months. Extended surgery (MS 89 months) was associated with prolonged survival compared with patients who underwent only chemoradiation (MS 5 months). Stage migration due to lymph node metastases, WHO-classification type C, and T3/4-status were associated with inferior survival in the univariate analysis. Extended surgery remained the only independent significant prognosticator in the multivariate analysis.
  
  
  CONCLUSIONS
  Extended surgery within multimodality treatments might offer survival advantage for advanced thymic malignancies with pleural spread. Patients with lymph node metastases and WHO classification type C might be at high risk of unresectability.
authors: Department of Thoracic Surgery, Helios-Klinikum Wuppertal, University Hospital Witten/Herdecke, Wuppertal, Germany.
authors: Servet
authors: S
authors: Bölükbas
authors: Division of Pulmonary, Critical Care and Occupational Medicine, University of Iowa, Iowa City, Iowa, United States.
authors: Michael
authors: M
authors: Eberlein
authors: Department of Thoracic Surgery, Dr. Horst Schmidt Klinik, Wiesbaden, Germany.
authors: Selma
authors: S
authors: Oguzhan
authors: Department of Thoracic Surgery, Dr. Horst Schmidt Klinik, Wiesbaden, Germany.
authors: Moritz
authors: M
authors: Schirren
authors: Department of Thoracic Surgery, Dr. Horst Schmidt Klinik, Wiesbaden, Germany.
authors: Stefan
authors: S
authors: Sponholz
authors: Department of Thoracic Surgery, Dr. Horst Schmidt Klinik, Wiesbaden, Germany.
authors: Joachim
authors: J
authors: Schirren
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D015182:Lymphatic Irradiation; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D010994:Pleura / Q000601:surgery*; D011379:Prognosis; D012189:Retrospective Studies; D013934:Thymectomy / Q000379:methods*; D013953:Thymus Neoplasms / Q000000981:diagnostic imaging / Q000401:mortality / Q000473:pathology* / Q000601:surgery*; D014057:Tomography, X-Ray Computed; D055815:Young Adult