Primary surgical removal
The treatment of choice for thymomas is primarily surgical removal. The entire thymus gland, including the surrounding fatty tissue, is removed “en bloc”. Until ten years ago, it was necessary to split the breastbone to safely remove the tumor tissue, but today it is the keyhole technique, so-called minimally invasive surgery, that ensures the gentle and safe removal of the thymoma. This can be performed either in the form of video-assisted thoracoscopy or robot-assisted in specialized centers. However, this is only possible in early stages, in advanced stages the removal must be performed openly. The most important goal of each operation is the complete removal of all tumor tissue. If completely removed, early stages of thymoma have an excellent early and long-term prognosis. However, the prognosis depends on the respective stage, i.e. above all on the size and extent of the thymoma.
Accompanying therapy
If the thymoma is at an advanced stage, an accompanying therapy in the form of chemotherapy may be necessary, either before or after surgery. Basically, it can be said that if adjacent or distant tissue is affected by tumor seeding, chemotherapy is recommended. Radiotherapy, on the other hand, is controversially discussed in all stages of thymoma and cannot generally be recommended as an accompanying therapy.
After successful treatment, a CT scan of the chest should be performed annually in the first five years after surgery and every two years up to the 10th year to detect recurrence. If a recurrence occurs, a second operation should be attempted, as this therapy is associated with the best prognosis.
Interdisciplinary tumor conference
In all cases, however, all patients suffering from a thymoma are discussed in an interdisciplinary tumor conference – in which specialists from tumor medicine, thoracic surgery, radiology, radio-oncology and pathology consult together and make recommendations based on the latest international findings and standards.