Objective

To identify patients who have undergone surgery for thymic neoplasms and review their operative management, subsequent histology and post-operative follow up. The aim was to evaluate the need to generate a structured management protocol across our network.

Methods

A retrospective analysis of surgery, pathology and outpatient databases across two tertiary referral hospitals in the network was performed to identify patients operated upon for thymic neoplasms between January 2009 and December 2014. The surgical approach used, intra-operative findings, subsequent histology and follow up of these patients were reviewed.

Results

42 patients who had undergone surgery locally were identified, of whom the majority (34/42) underwent surgery via sternotomy. Around 75% of the tumours identified were classified as Masaoka-Koga stage I. 26 patients had an R0 resection (15/26 stage I, 11/26 stages II-IV). 3 had post-operative radiotherapy (POR). 13 patients had an R1 resection (12/13 stage II, 1/13 thymic carcinoma). 12 had POR. 3 patients had an R2 resection (2/3 thymic carcinoma, 1/13 stage III). 2 received POR.

Conclusion

Whilst our patients did seem to be managed reasonably consistently, there were some noticeable inconsistencies around stage specific adjuvant chemoradiotherapy decision making, length and frequency of follow up, and choice of imaging modality for surveillance. Early stage patients, who often were treated with surgery alone, were particularly at risk of being lost to follow up. Our experience highlights the need for a robust follow up protocol as part of a multidisciplinary approach.