Redo operation for recurrent, disseminated and metastaic thymoma

Ⅱ．呼吸器領域 5．胸腺腫再発・播種・転移に対する再手術

In this article, redo operation for recurrent thymoma was reviewed. Several cohort studies according the issues of the role of surgery for recurrent thymoma have been reported. Although these studies are of relatively small of seize and have selection biases, most of authors recommend surgical treatment for recurrent thymoma. Best results are expected in case of complete resection of the recurrence. Usually local recurrences are approached by a resternotomy, a clamshell incision or a hemi clamshell incision. Resternotomy associates with the risks of injury of brachiocepharic vein, heart and lungs and catastrophic hemorrhage. The degree of retrosternal adhesions and tumor invasion caused by recurrence are diverse. An oscillating saw is recommended for dividing the sternum. Video-assisted thoracic surgery(VATS)may help to dissect retrosternal adhesions. The most frequent pattern of recurrence is pleural implants after the initial operation with complete resection. In those cases, thoracotomy or VATS are often used. Redo operations for distant metastasis of thymoma are rare. Pleuropneumonectomy for pleural implantation is associated high morbidity and mortality rates, therefore this option is suitable for highly selected patients. Preoperative radiological evaluation of recurrent thymoma is important on planning of approach procedures.