AB027. Surgery for de novo stage IVa thymomas: time to broaden our horizons?—a single-centre retrospective analysis
Original Research

AB027. Surgery for de novo stage IVa thymomas: time to broaden our horizons?—a single-centre retrospective analysis

Giacomo Rabazzi1, Vittorio Aprile1, Stylianos Korasidis2, Maria Giovanna Mastromarino2, Alessandra Lenzini2, Greta Alì1, Iacopo Petrini3, Marcello Carlo Ambrogi1, Marco Lucchi1

1Department of Surgical, Medical and Molecular Pathology and Critical Care Medicine, University of Pisa, Pisa, Italy; 2Division of Thoracic Surgery; Cardiac, Thoracic and Vascular Department, University Hospital of Pisa, Pisa, Italy; 3Department of Translational Research and of New Surgical and Medical Technologies, University of Pisa, Pisa, Italy

Correspondence to: Giacomo Rabazzi, MD. Department of Surgical, Medical and Molecular Pathology and Critical Care Medicine, University of Pisa, Via Savi, 10, Pisa, Tuscany, 56126, Italy. Email: giacomo.rabazzi@gmail.com.

Background: De novo stage IVa thymomas, characterised by plural or pericardial dissemination at diagnosis, pose significant management challenges. The purpose of this article is to describe our experience with a two-step surgical strategy in the management of de novo stage IVa thymomas, and to evaluate its impact on oncological outcomes.

Methods: Clinical and oncological data were retrospectively collected for all patients with pleural de novo stage IVa thymoma, classified according to the 9th tumor-node-metastasis (TNM) staging system, who underwent surgical treatment at the University Hospital of Pisa between January 2005 and December 2024. Variables included clinical and surgical characteristics, histological subtype [per World Health Organization (WHO) classification], and adjuvant treatments. Overall survival (OS) and disease-free survival (DFS) were analysed, stratifying patients based on surgical timing: single-step surgery (primary tumour and metastases treated simultaneously) versus two-step surgery (procedures performed 3–6 months apart).

Results: Thirty patients (14 males, 16 females; median age 47 years, range 29–82 years) were included, 13 (43.3%) of whom had myasthenia gravis. All patients had pleural dissemination at diagnosis: 33% had a single metastasis, while one-third of patients had more than 10 implants. Neoadjuvant chemotherapy was administered in 63.3% of cases when judged potentially resectable. Nineteen patients (63.3%) underwent single-step surgery with radical intent on the primary tumour and pleural metastases. Eleven patients (36.7%) underwent two-step surgery, with the first procedure addressing the primary tumour, with a lower rate of post-operative complications and an earlier discharge, followed by a second operation targeting pleural metastases. The most common histological subtypes were B3 (36.7%), B2 (23.3%), and combined B2/B3 (23.3%). Twenty-five patients received adjuvant therapy, 8 of whom were prior to the second surgical procedure.

Conclusions: Managing de novo stage IVa thymomas usually requires a multimodal approach. Given the typically indolent behavior of the disease, a two-step surgical strategy does not compromise the oncological outcomes, compared to single-step surgery, but may reduce the post-operative complication rate.

Keywords: Thymoma; de novo stage IVa; multimodality treatment; thymic surgery; two-step surgery

Figure 1 Kaplan-Meier analysis of survival curves for patients with de novo stage IVa thymomas. (A) Overall survival curves stratified according to the timing of surgical resection; (B) disease-free survival curves stratified according to the timing of surgical resection. M, metastasis; T, tumor.

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Footnote

Funding: None.

Conflicts of Interest: All authors have completed the ICMJE uniform disclosure form (available at https://med.amegroups.com/article/view/10.21037/med-25-ab027/coif). The authors have no conflicts of interest to declare.

Ethical Statement: The authors are accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. The study was conducted in accordance with the Declaration of Helsinki and its subsequent amendments. The study was approved by the institutional ethics committee of University of Pisa (No. 27521) and individual consent for this retrospective analysis was waived.

Open Access Statement: This is an Open Access article distributed in accordance with the Creative Commons Attribution-NonCommercial-NoDerivs 4.0 International License (CC BY-NC-ND 4.0), which permits the non-commercial replication and distribution of the article with the strict proviso that no changes or edits are made and the original work is properly cited (including links to both the formal publication through the relevant DOI and the license). See: https://creativecommons.org/licenses/by-nc-nd/4.0/.

doi: 10.21037/med-25-ab027
Cite this abstract as: Rabazzi G, Aprile V, Korasidis S, Mastromarino MG, Lenzini A, Alì G, Petrini I, Ambrogi MC, Lucchi M. AB027. Surgery for de novo stage IVa thymomas: time to broaden our horizons?—a single-centre retrospective analysis. Mediastinum 2025;9:AB027.

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