Review
The Role of Surgery in the Management of Thymoma: A Systematic Review

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The literature describing multimodal treatment of thymomas consists almost exclusively of retrospective case series. We have used a systematic review to investigate the role of surgery in the management of thymomas. The use of surgery as the sole therapeutic maneuver in thymoma depends on the stage considered. Subtotal resection followed by adjuvant treatment may prolong survival, but studies are equivocal. Some data supports re-resection of recurrent thymoma in the belief that survival will be prolonged. Approaches to thymectomy other than sternotomy in early stage thymoma are technically sound, but long-term outcome data are lacking.

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Literature Search Strategy

A search of the MEDLINE database was performed with the keywords “thymoma” and “surgery” using the following limits: English language only, humans only, and published after 1981 (the year in which the Masaoka staging system was published). The Cochrane database, the National Guideline Clearinghouse (http://www.guideline.gov/index.asp) and abstracts from the 2004 and 2007 American Association of Thoracic Surgery meetings were also searched for English language abstracts or manuscripts related to

Literature Search Results

Our search strategy yielded 616 abstracts. Using our selection criteria we recovered a single prospective, randomized controlled trial and 23 retrospective series with between 40 and 1,093 patients. The patients in these studies were subjected to various combinations of surgery, radiotherapy, and chemotherapy. Patients within and between studies were very heterogeneous with respect to treatment protocols. Several small case series of between 1 and 22 patients were used in our discussion of

Comment

A significant limitation to generation of evidenced-based recommendations in the management of rare diseases is the paucity of prospective data on which to soundly base those recommendations. In the case of thymomas (with a single exception) all of the English language literature consists of retrospective case series with inconsistently applied treatment regimens. Notwithstanding the fact that surgeons may rarely encounter such diseases, treatment should be based on the best available evidence.

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