Thymectomy

Thymectomy is the surgical removal of the thymus, a lymphoid organ located in the anterior mediastinum behind the sternum. The procedure may aim for complete thymus removal or extended thymectomy, which includes adjacent mediastinal tissue to reduce residual thymic tissue.

Indications include thymic epithelial tumors such as thymoma and thymic carcinoma, thymic hyperplasia, and autoimmune or hematologic conditions such as myasthenia gravis, pure red cell aplasia, and Good syndrome. In myasthenia gravis, thymectomy can improve weakness and may reduce the need for immunosuppressive therapy in selected patients, though outcomes vary by disease subtype and patient factors.

Surgical approaches vary by tumor size, invasion, and surgeon expertise. Traditional open thymectomy uses a median sternotomy. Minimally invasive options include video-assisted thoracoscopic surgery (VATS) and robotic-assisted thymectomy, performed through chest ports and sometimes a subxiphoid or unilateral approach. Substantial tumors or thymic invasion of surrounding structures may require an open approach for adequate exposure and complete resection. Preoperative imaging with CT or MRI, along with assessment of the course of the disease, helps guide approach.

Outcomes depend on the indication. Complete resection is a key factor for thymoma prognosis and can improve MG symptoms in many patients, though not all. Risks are those common to mediastinal surgery and include infection, bleeding, injury to the phrenic or recurrent laryngeal nerves, pneumothorax, and chylothorax. Recovery is typically shorter with minimally invasive techniques but varies with extent of surgery and concurrent conditions.