Abstract
AB010. Surgical treatment strategy for thymic cancer invading the aorta: a case report
Yasushi Shintani, Kenji Kimura, Eriko Fukui, Toru Kimura, Takashi Kanou, Naoko Ose
Department of General Thoracic Surgery, Osaka University Graduate School of Medicine, Suita, Osaka, Japan
Correspondence to: Yasushi Shintani, MD, PhD. Department of General Thoracic Surgery, Osaka University Graduate School of Medicine, 2-2-L5, Yamadaoka, Suita, Osaka 565-0871, Japan. Email: yshintani@thoracic.med.osaka-u.ac.jp.
Background: Thymic carcinoma is a rare but aggressive tumor, and multidisciplinary treatment is necessary to improve prognosis. Although complete surgical resection is a prognostic factor, it is not always an option for advanced tumors because of locoregional invasion. Especially, surgery for aortic (Ao) involvement in thymic cancer cases is challenging. We performed complete resection in 6 cases with reconstruction of ascending Ao in 2 and Ao arch in 4 from 2014 to 2023. Herein, we present the surgical techniques for thymic carcinoma with Ao invasion.
Case Description: Case 1: a man in his 50s was diagnosed with thymic carcinoma with invasion to the ascending Ao and superior vena cava (SVC). After chemoradiotherapy, resection was performed. A median sternotomy was used, and with circulatory arrest, the tumor involving the ascending Ao, SVC, and bilateral brachiocephalic veins (BCV) was resected. Reconstruction of the ascending Ao and bilateral BCV was then carried out. The operation time was 678 minutes. The patient has remained recurrence-free for 10 years. Case 2: a man in his 70s had a thymic carcinoma invading from the ascending Ao to the Ao arch. He was referred for surgery after chemotherapy, and a hemi-clamshell (HCS) approach with circulatory arrest was employed for tumor resection and replacement of the Ao arch. The operation time was 678 minutes. The patient has been recurrence-free for 8 years. Case 3: a man in his 40s was treated with chemotherapy for thymic carcinoma with malignant pericardial effusion. The tumor shrank, and the effusion disappeared, leading to a salvage surgery plan. Using the HCS approach, bypasses were performed from the ascending Ao to the right brachiocephalic artery, left common carotid artery, and left subclavian artery. Subsequently, under beating heart conditions, the arch was replaced, and a left pneumonectomy with right pulmonary artery plasty was performed for tumor resection. The operation time was 958 minutes. The patient has been recurrence-free for 5 years.
Conclusions: The approach and resection method for mediastinal tumors suspected of Ao invasion vary greatly depending on the malignancy and invasion site. Close collaboration with cardiac surgeons is essential, and surgical planning involving great vessel reconstruction is necessary.
Keywords: Thymic cancer; surgery; aorta; reconstruction; case report
Acknowledgments
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-24-ab010/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. All procedures performed in this study were in accordance with the ethical standards of the institutional and/or national research committee(s) and with the Helsinki Declaration (as revised in 2013). Written informed consent was obtained from the patients for the publication of this case report. A copy of the written consent is available for review by the editorial office of this journal.
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-24-ab010
Cite this abstract as: Shintani Y, Kimura K, Fukui E, Kimura T, Kanou T, Ose N. AB010. Surgical treatment strategy for thymic cancer invading the aorta: a case report. Mediastinum 2024;8:AB010.
