Surgery for thymus cancer

Most people with thymus cancer will have surgery. The type of surgery you have depends mainly on the stage and location of the cancer. When planning surgery, your healthcare team will also consider other factors, such as your overall health and if it is safe for you to have surgery.

Surgery may be done for different reasons. You may have surgery to:

• completely remove the tumour
• remove as much of the tumour as possible before other treatments
• reduce pain or ease symptoms (called palliative surgery)

Surgery for thymus cancer is usually done by a thoracic surgeon, who is a doctor that specializes in surgery of the chest.

The following types of surgery are used to treat thymus cancer. You may also have other treatments before or after surgery.

A total thymectomy completely removes the thymus. Any cancer that has grown into tissue around the thymus is removed at the same time as the thymus (also called an en bloc resection or an extended thymectomy), especially when the thymus cancer is associated with myasthenia gravis.

A total thymectomy is done using one of the following approaches – a median sternotomy, a bilateral anterolateral thoracotomy with transverse sternotomy or a thoracoscopy.

A median sternotomy is the most common type of surgery for thymus cancer. It is done using a general anesthetic (you will be asleep). The surgeon makes a cut (incision) in the skin over the breastbone (sternum) in the middle of the chest. The breastbone is split in half down the middle with a special saw so the surgeon can reach the thymus and remove it.

The surgeon will put a flexible chest tube into the chest cavity that is connected to a bottle outside the body. Chest tubes are used to drain blood, other fluids and air from the space around the lungs after surgery. They are left in place until x-rays show that the blood, fluids or air have been drained and the lungs can fully expand.

After surgery and once chest tubes are in place, the surgeon wires the breastbone back together and closes the cut in the chest with stitches.

You usually need to stay in the hospital for several days after a median sternotomy.

A bilateral anterolateral thoracotomy with transverse sternotomy is also called a clamshell incision. It may be done if the cancer has spread throughout the lower part of the mediastinum.

This surgery is done using a general anesthetic. The surgeon makes 2 small cuts between the ribs on each side of the chest. These small cuts are connected by one larger cut just under the breasts. The breastbone is cut with scissors or a saw across the middle. Then the ribs are spread apart using a special tool (retractor) so the surgeon can reach the tumour.

Chest tubes are put in to drain blood, other fluids and air from the space around the lungs after surgery. They are left in place until x-rays show that the blood, fluids or air have been drained and the lungs can fully expand.

After surgery and once chest tubes are in place, the surgeon removes the retractor and wires the breastbone together. The cut in the chest is closed with stitches.

You usually need to stay in the hospital for several days after the surgery.

A thoracoscopy is a less invasive way of removing the thymus for early stages of thymus cancer. It is done using an endoscope (called a thoracoscope) and surgical tools that are inserted through small cuts on one or both sides of the chest between the ribs. The thoracoscope may have a small video camera attached to it (called video-assisted thoracic surgery, or VATS).

Find out more about a thoracoscopy.

Debulking surgery removes as much of the cancer as possible. This surgery may be used for advanced thymus cancer to help reduce the symptoms caused by growth of the tumour.

Experts disagree about the role of debulking surgery for advanced thymoma and thymic carcinoma that has spread to organs near the thymus. Some research has suggested that it may help improve survival, while other studies suggest that there is no advantage compared to a biopsy and radiation therapy.

Side effects can happen with any type of treatment for thymus cancer, but everyone’s experience is different. Some people have many side effects. Other people have only a few side effects.

If you develop side effects, they can happen any time during, immediately after or a few days or weeks after surgery. Sometimes late side effects develop months or years after surgery. Most side effects will go away on their own or can be treated, but some may last a long time or become permanent.

Side effects of surgery will depend mainly on the type of surgery and your overall health.

Surgery for thymus cancer may cause these side effects:

• pain
• wound infection
• bleeding
• irregular heart rate (dysrhythmia)
• lung infection (pneumonia)
• difficulty breathing

Find out more about surgery and side effects of surgery. To make the decisions that are right for you, ask your healthcare team questions about surgery.