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B. Aramini

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    Poster Session (ID 8)

    • Event: ACLC 2018
    • Type: Poster Session
    • Track:
    • Presentations: 1
    • Moderators:
    • Coordinates: 11/07/2018, 00:00 - 00:00, Poster Hall
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      P034 - A Case of Stage IIIA Thymoma Underwent Thymectomy with the Subxiphoid Approach (ID 34)

      00:00 - 00:00  |  Author(s): B. Aramini

      • Abstract

      Thymectomy is recommended for the treatment of thymoma. The current literature suggests that minimally invasive surgery may be as effective or better than open thymectomy for treating small, early-stage thymic malignancies, possibly with no infiltration of the posterior structures. We show the potential benefits in an advanced thymoma undergoing thymectomy with subxiphoid approach.

      A 55-year-old male came to our attention in May 2018 for blepharoptosis starting 3 months prior and worsening in the preceding month. Chest X-ray, CT scan, and RMI (Fig. 1A-1B) with enhancement showing a mass of 2 cm x 1.5 cm x 1 cm in the anterior mediastinum and infiltrating the joint position of the vena cava and the venae innominate and the anterior segment of the right upper lobe of the lung (Fig.2A-2B). The level of anti-acetylcholine antibodies in the blood was in the normal range, with no neurologic signs for myasthenia gravis. After clinical stabilization, the patient underwent thymectomy plus wedge resection of the right upper lobe of the lung using a subxiphoid approach. A hemostatic patch was used for pericardial repair.

      Four hours operation with no intraoperative complications. Patient was extubated in the intensive care unit on the third postoperative day. Intravenous immunoglobulin was given immediately after surgery and pyridostigmine orally three days after surgery to prevent myasthenic crisis. Histology was positive for B3 thymoma Masaoka-Koga, stage IIIA. Patient was discharged after seven days,no morbidities and little pain.

      We believe think that the elevation of the sternum creates enough space through the anterior mediastinum to conduct more complicated procedures even if the thymoma is in an advanced stage, although a quality surgical experience, a high-volume surgical center, and careful selection of the patients are mandatory for improving postoperative outcomes. Fig.1A-B. RMI shows a thymoma infiltrating the vena cava and the right upper lobe of the lung. Fig.1C. Resection of the tumor at the joint position between the innominate vein and vena cava. Fig.1D. Thymus is completely removed. fig. 1 a-b-c-d.jpg