Iterative Surgical Treatment for Repeated Recurrences After Complete Resection of Thymic Tumors.
BACKGROUND
In this study, we evaluated if surgical treatment and iterative operations could confer a survival advantage for patients with recurrent or repeated recurrences of thymoma.


METHODS
Between 1984 and 2014, 53 of 515 (10%) patients had recurrences after complete thymoma resection. Demographics, stage, treatment, and pathologic findings were statistically analyzed to identify survival prognostic factors.


RESULTS
Thirty-eight of 53 (72%) patients underwent resection of recurrent thymoma; 32 (84%) underwent complete resection. Fifteen (28%) patients did not undergo resection; 3 (20%) received chemotherapy alone, 10 (67%) received chemoradiotherapy, and 2 (13%) received supportive care. At univariate analysis, World Health Organization (WHO) AB + B1 histologic types (p < 0.0001), R0 resection (p < 0.0001), myasthenia gravis (MG) (p = 0.02), and adjuvant therapy after recurrence (p = 0.03) were significant prognostic factors. At multivariate analysis, complete resection (p = 0.0003) was the only significant prognostic factor. Among patients with repeated resections, those undergoing complete resection had better survival than did those undergoing incomplete resection or no operative procedure (p = 0.02). Seven patients are alive and free of disease, with a median survival of 115 months (70-161 months) and 149 months (61-201 months) from the first recurrence and from thymoma resection, respectively.


CONCLUSIONS
Complete resection is a viable treatment option for selected patients with recurrent thymomas. In cases of technically resectable repeated recurrences, repeated operations should be considered.
Thoracic Surgery Unit, Second University of Naples, Naples, Italy. Electronic address: alfonso.fiorelli@unina2.it.
Alfonso
A
Fiorelli
Thoracic Surgery Unit, University of Rome Sapienza, Rome, Italy.
Antonio
A
D'Andrilli
Thoracic Surgery Unit, Sant'Andrea Hospital, University of Rome Sapienza, Rome, Italy.
Camilla
C
Vanni
Thoracic Surgery Unit, Second University of Naples, Naples, Italy.
Roberto
R
Cascone
Thoracic Surgery Unit, University of Rome Sapienza, Rome, Italy.
Marco
M
Anile
Thoracic Surgery Unit, University of Rome Sapienza, Rome, Italy.
Daniele
D
Diso
Thoracic Surgery Unit, University of Perugia, Perugia, Italy; Alma Mater Studiorum, University of Bologna, Bologna, Italy.
Valentina
V
Tassi
Thoracic Surgery Unit, University of Perugia, Perugia, Italy.
Jacopo
J
Vannucci
Department of Radiology, Second University of Naples, Naples, Italy.
Nicola
N
Serra
Thoracic Surgery Unit, University of Perugia, Perugia, Italy.
Francesco
F
Puma
Thoracic Surgery Unit, Sant'Andrea Hospital, University of Rome Sapienza, Rome, Italy.
Erino Angelo
EA
Rendina
Thoracic Surgery Unit, University of Rome Sapienza, Rome, Italy.
Federico
F
Venuta
Thoracic Surgery Unit, Second University of Naples, Naples, Italy.
Mario
M
Santini
D000328:Adult; D000367:Age Factors; D000368:Aged; D002423:Cause of Death; D016208:Databases, Factual; D005260:Female; D006801:Humans; D015994:Incidence; D007558:Italy; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009364:Neoplasm Recurrence, Local / Q000453:epidemiology / Q000473:pathology / Q000601:surgery*; D011237:Predictive Value of Tests; D016016:Proportional Hazards Models; D012086:Reoperation / Q000379:methods / Q000401:mortality / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D018570:Risk Assessment; D012737:Sex Factors; D016019:Survival Analysis; D013934:Thymectomy / Q000009:adverse effects / Q000379:methods*; D013945:Thymoma / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D013953:Thymus Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D016896:Treatment Outcome