Operative approaches for thymectomy: clinical characteristics and classification variant

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Abstract

Currently, surgical intervention is the “gold standard” treatment of thymus tumors. Radical removal of the thymus gland in a single block, including the tumor, adjacent lymph nodes, and surrounding tissue of the anterior mediastinum, is a prerequisite for achieving satisfactory immediate and long-term results. The need for “maximum” thymectomy together with anterior mediastinal fiber is attributed to the fact that, along with other long-term survival factors (stage of tumor progression and histological subtype of the tumor), 45–50% of deaths in the long-term follow-up period are due to the recurrence of thymoma and 15–20% are caused by a progressive course of myasthenia gravis. The results of domestic and foreign studies on the implementation of thymectomy from various surgical approaches are analyzed. These include traditional thoracotomy and sternotomy, video-assisted and robot-assisted interventions, and combined operative accesses. The data presented are based on systematic reviews, retrospective cohort studies, clinical cases, and experimental studies using text databases PubMed, Google Scholar, and eLibrary.ru. The clinical characteristics of each operative access are given with an emphasis on technical features and advantages and disadvantages of thymectomy. The immediate results of surgical treatment of patients with thymus gland neoplasms are presented. Additional methods of visualization and physical preparation of anterior mediastinal tissues are described separately, which help increase the safety and effectiveness of surgical intervention. Currently, low-traumatic video-assisted surgical interventions are widely used in thoracic surgery, gradually replacing traditional “open” operations. Nevertheless, the variety of proposed options for surgical access, lack of clear indications and contraindications to various interventions on the thymus gland, and discrepancies in the use of various terms determine the need to develop a modern classification of surgical accesses for performing thymectomy. Taking into account world literature data and our own experience, a classification of operative accesses for performing thymectomy is proposed.

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About the authors

Ivan V. Dmitrochenko

Kirov Military Medical Academy

Author for correspondence.
Email: dmitrochenkoiv@yandex.ru
ORCID iD: 0000-0002-2903-9107
SPIN-code: 1737-2737
Scopus Author ID: 57216862579

thoracic surgeon

Russian Federation, Saint Petersburg

Evgeny V. Levchenko

Petrov Research Institute of Oncology

Email: LevchenkoEV@gmail.com
ORCID iD: 0000-0003-3837-2515
SPIN-code: 2743-8968
Scopus Author ID: 55658789500

MD, Dr. Sci. (Med.)

Russian Federation, Saint Petersburg

Ilya I. Dzidzava

Kirov Military Medical Academy

Email: dzidzava@mail.ru
ORCID iD: 0000-0002-5860-3053
SPIN-code: 7336-9643
Scopus Author ID: 8901380100
ResearcherId: Q-1992-2016

MD, Dr. Sci. (Med.)

Russian Federation, Saint Petersburg

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