Simultaneous videothoracoscopic resection for thymoma and lung squamous cell carcinoma, and review of the literature

The coexistence of non-small cell lung cancer (NSCLC) and thymoma is extremely rarely reported in the literature [1]. In recent years, in parallel with advances in minimally invasive surgical techniques, resection of both thymic and lung tumors can be performed with the video assisted thoracic surgery (VATS) method [2]. Here we present a case of a patient who underwent simultaneous surgical resection by VATS for both thymoma and squamous cell lung carcinoma. A fifty-seven-year-old female patient presented to us with cough complaint. Thorax tomography revealed a mass with 7 cm diameter at the right upper lobe and a thymic lesion at the anterior mediastinum (Figure 1 A). Histopathologic results of transthoracic Tru-cut biopsy were reported as squamous cell carcinoma and type AB thymoma. On positron emission tomography-computed tomography (PET-CT), pathologically increased uptake of 18F-FDG was detected at lung cancer and thymic tumor, with SUV-max 10 and 3 respectively (Figure 1 B). Invasive mediastinal staging was performed by endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) and there was no nodal metastasis. The patient had no myasthenia gravis symptoms or signs. We planned simultaneous thymectomy and right upper lobectomy with mediastinal lymph node dissection in the same incision. A utility incision was made from the right anterior 4th intercostal space and a camera port incision was made at the right 8th intercostal space-posterior axillary line junction. Firstly, the chief surgeon performed the right upper lobectomy and mediastinal lymph node dissection procedure from the patient’s anterior, with pulmonary vein-pulmonary artery-bronchus sequencing. In this way, hilar, interlobar, paratracheal, subcarinal and pulmonary ligament lymph nodes were dissected. Then, for the thymectomy procedure, the chief surgeon was positioned behind the patient and the operating table was sided posteriorly. Thymic fat tissue over the pericardium was dissected with an energy device. Figure 2 shows intraoperative view of thymoma and surrounding structures. Thymic tissue was dissected with blunt and sharp dissections posteriorly to the vena cava and superiorly to the left brachiocephalic vein. The thymic vein that arose from the left brachiocephalic vein was clipped and divided. The thymectomy procedure was completed by advancing to the left hemithorax and sparing both phrenic nerves. Total time of surgery was 170 min and total blood loss was...


View full text...