title: Radical surgical resection of advanced thymoma and thymic carcinoma infiltrating the heart or great vessels with cardiopulmonary bypass support.
abstract: BACKGROUND
  Radical surgical resection of advanced thymic tumors invading either the heart or great vessels facing towards the heart is uncommonly performed because of the potential morbidity and mortality. To achieve a complete tumor resection, the use of cardiolpulmonary bypass (CPB) support might be necessary.
  
  
  METHODS
  Retrospective analysis of the results in six patients, who underwent radical tumor resection with CBP support.
  
  
  RESULTS
  Mean age was 46 years (27 to 66 years) and five patients were male. Tumor infiltration of the heart or the great vessels was evident in all patients. Five patients underwent induction therapy. Two patients were operated in complete cardioplegic arrest (antegrade cerebral perfusion: n = 1). Arterial cannulation of the ascending aorta (n = 5) or the femoral artery (n = 1) and venous cannulation of the right atrium (n = 4) or the femoral vein (n = 2) were performed. Resection of the left brachiocephalic vein (n = 6), resection of the superior caval vein (n = 2), the ascending aorta (n = 1) and the complete aortic arch with outgoing branches (n = 1) were performed. A macroscopic complete resection (R0/R1) was achieved in five patients, whereas one patient was resected incompletely (R2). In-hospital mortality was 0 %. Three (50 %) patients needed operative revision (hematothorax: n = 2, chylothorax: n = 1). All patients had a complicated postoperative course and developed respiratory insufficiency.
  
  
  CONCLUSIONS
  Locally advanced thymoma/thymic carcinoma invading the heart or great vessels can be treated with radical surgical resection alongside with increased perioperative morbidity. The usage of CBP improves the chance of complete tumor resection in selected patients and might lead to a prolonged survival.
authors.affiliation: Department of Thoracic Surgery, University Medical Center Regensburg, Franz-Josef-Strauß-Allee 11, D-93053, Regensburg, Germany. micha.ried@t-online.de.
authors.forename: Michael
authors.initials: M
authors.lastname: Ried
authors.affiliation: Department of Thoracic Surgery, University Medical Center Regensburg, Franz-Josef-Strauß-Allee 11, D-93053, Regensburg, Germany. reiner.neu@ukr.de.
authors.forename: Reiner
authors.initials: R
authors.lastname: Neu
authors.affiliation: Department of Neurology, University Regensburg at the District Medical Center, Regensburg, Germany. berthold.schalke@medbo.de.
authors.forename: Berthold
authors.initials: B
authors.lastname: Schalke
authors.affiliation: Department of Thoracic Surgery, University Medical Center Regensburg, Franz-Josef-Strauß-Allee 11, D-93053, Regensburg, Germany. marietta.suesskind-von@ukr.de.
authors.forename: Marietta
authors.initials: M
authors.lastname: von Süßkind-Schwendi
authors.affiliation: Department of Thoracic Surgery, Hospital Barmherzige Brüder Regensburg, Regensburg, Germany. zsolt.sziklavari@barmherzige-regensburg.de.
authors.forename: Zsolt
authors.initials: Z
authors.lastname: Sziklavari
authors.affiliation: Department of Thoracic Surgery, University Medical Center Regensburg, Franz-Josef-Strauß-Allee 11, D-93053, Regensburg, Germany. hans-stefan.hofmann@ukr.de.|Department of Thoracic Surgery, Hospital Barmherzige Brüder Regensburg, Regensburg, Germany. hans-stefan.hofmann@ukr.de.
authors.forename: Hans-Stefan
authors.initials: HS
authors.lastname: Hofmann
mesh_terms: D000328:Adult; D000368:Aged; D001011:Aorta / Q000601:surgery; D001013:Aorta, Thoracic / Q000473:pathology; D002315:Cardiopulmonary Bypass / Q000379:methods; D005260:Female; D006325:Heart Atria / Q000473:pathology; D017052:Hospital Mortality; D006801:Humans; D008297:Male; D008875:Middle Aged; D009361:Neoplasm Invasiveness; D011183:Postoperative Complications / Q000601:surgery; D012189:Retrospective Studies; D013945:Thymoma / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D013953:Thymus Neoplasms / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D014057:Tomography, X-Ray Computed; D014656:Vascular Surgical Procedures / Q000379:methods; D014683:Vena Cava, Superior / Q000473:pathology