Management of Thymoma

For purposes of this survey, participants were asked to assume that they were consulting on a middle aged patient who had findings on CT compatible with a small (2 cm) encapsulated thymoma. The patient had no symptoms related to the abnormality. �The patient was otherwise healthy and had no symptoms of myasthenia gravis.

Over 90% of respondents manage patients with thymomas, indicating that the subsequent responses reflect the opinions of active practitioners.� Almost half of the respondents routinely refer such patients for a neurologic evaluation, even in the absence of myasthenic symptoms.

Additional diagnostic/evaluation procedures are used quite commonly: MRI in 25%, needle biopsy in 25%, serum tumor markers in almost 2/3 of respondents, and open biopsy in 10%.

The most common surgical approach for such patients is a standard thymectomy.� An extended thymectomy was identified as the preferred approach in 15% of respondents.

There was no clear opinion as to whether a minimally invasive approach was appropriate for this patient.� About half of the respondents indicated a preference for an open approach.� Of the respondents who believed a minimally invasive approach was appropriate, there was no consensus as to the optimal VATS technique.

1. Do you manage patients with thymoma?
	answered question		359
	skipped question		0
		Response Percent	Response Count
Yes		96.1%	345
No		3.9%	14

2. Do you typically refer patients of this type for a neurologic evaluation in the absence of symptoms suggestive of myasthenia gravis?
	answered question		356
	skipped question		3
		Response Percent	Response Count
Yes		43.0%	153
No		57.0%	203

3. Do you normally perform any additional diagnostic procedure(s)? Please check which procedures you would normally perform.
	answered question		282
	skipped question		77
		Response Percent	Response Count
MRI		26.2%	74
Needle biopsy		25.5%	72
Serum tumor markers		62.8%	177
Parasternal mediastinotomy or thoracoscopy for diagnosis		12.1%	34

4. What is your preferred approach to managing this problem?
	answered question		358
	skipped question		1
		Response Percent	Response Count
Standard thymectomy (complete thymectomy including pericardial fat extending to the phrenic nerves bilaterally, including both upper poles of the thymus)		76.3%	273
Extended thymectomy (standard thymectomy plus additional dissection in the mediastinum and neck aimed at removing all extracapsular nests of thymic tissue)		16.5%	59
Other		7.3%	26

5. Do you believe that a minimally invasive approach is adequate for surgical management of this problem?
	answered question		354
	skipped question		5
		Response Percent	Response Count
Yes		54.8%	194
No		45.2%	160

6. If you would use a minimally invasive approach for management of this problem, which approach do you normally prefer?
	answered question		329
	skipped question		30
		Response Percent	Response Count
Right VATS		31.6%	104
Left VATS		11.9%	39
Bilateral VATS		18.5%	61
Transcervical		12.8%	42
Other / not applicable		25.2%	83

7. In what region is your surgical practice based?
	answered question		358
	skipped question		1
		Response Percent	Response Count
North America		39.4%	141
Europe		24.6%	88
South America		6.7%	24
Asia		24.0%	86
Africa		5.3%	19