Surgery for Thymus Cancer

Whenever possible, surgery is used to treat thymus tumors (thymomas and thymic carcinomas). If you have a thymus tumor, one of the first things your doctor will do is to try to figure out if is completely resectable (removable) with surgery. Imaging tests are used to do this.

The most common surgery for thymus tumors is complete removal of the thymus (including any tumor). This is called a thymectomy. The surgeon will also try to remove any areas of tumor that have spread outside of the thymus. If the tumor has grown into nearby structures, parts of those structures also might need to be removed. This could mean removing parts of the pleura (the outer lining of the lung), pericardium (the sac surrounding the heart), nerves, the superior vena cava (a large vein leading to the heart), and/or lung.

The surgeon will also remove nearby lymph nodes so they can be checked for cancer.

Surgical approaches to removing the thymus

This surgery can be done in different ways.

The standard approach has been through a long incision (cut) down the middle of the chest that splits the sternum (breastbone). This approach is called a median sternotomy.

In some cancer centers, smaller thymus tumors might be removed through several smaller incisions using long, thin surgical tools. This is known as a minimally invasive thymectomy (MIT). The surgeon can either hold the tools directly or can sit at a control panel to operate very precise robotic arms to do the surgery. An advantage of MIT is that it usually results in less pain and a shorter recovery time after surgery. But the surgeon has to operate in a smaller space, so not all thymus tumors can be removed this way.

The surgeon will also remove nearby lymph nodes so they can be checked for cancer.

Sometimes, chemotherapy may be given before surgery to try to shrink the tumor so that it can be more easily and completely removed. This is known as neoadjuvant therapy.

Possible side effects of surgery for thymus cancer

Possible complications depend on the extent of the surgery and on a person's health beforehand. Serious problems can include:

• Excess bleeding
• Infection at the incision site
• Serious lung problems, including pneumonia
• Damage to important nerves near the thymus

You will most likely need to stay in the hospital for several days after surgery. If the surgeon opens your chest for the operation, the incision will hurt for some time after surgery. You will probably have to limit your activity for at least a month or two.

If the cancer has spread there, some people may need to have part or all of a lung removed. If your lungs are in good condition (other than the presence of the cancer) you can usually go back to normal activities after part of a lung or even an entire lung has been removed. If you already have lung problems such as emphysema or chronic bronchitis (which are common among people who smoke heavily), you may become short of breath with activities after surgery.