Thorac cardiovasc Surg
DOI: 10.1055/s-0039-1700883
Original Thoracic
Georg Thieme Verlag KG Stuttgart · New York

Surgical Cytoreduction and HITOC for Thymic Malignancies with Pleural Dissemination

Till Markowiak
1  Department of Thoracic Surgery, University Medical Center Regensburg, Regensburg, Germany
,
Reiner Neu
1  Department of Thoracic Surgery, University Medical Center Regensburg, Regensburg, Germany
,
Mohammed Khalid Afeen Ansari
1  Department of Thoracic Surgery, University Medical Center Regensburg, Regensburg, Germany
,
Christian Großer
2  Department of Thoracic Surgery, Hospital Barmherzige Brüder Regensburg, Regensburg, Germany
,
Monika Klinkhammer-Schalke
3  Tumor Center, University Institute of Quality Assurance and Health Services Research, Regensburg, Germany
,
Hans-Stefan Hofmann
1  Department of Thoracic Surgery, University Medical Center Regensburg, Regensburg, Germany
2  Department of Thoracic Surgery, Hospital Barmherzige Brüder Regensburg, Regensburg, Germany
,
Michael Ried
1  Department of Thoracic Surgery, University Medical Center Regensburg, Regensburg, Germany
› Author Affiliations
Further Information

Publication History

13 May 2019

22 September 2019

Publication Date:
15 November 2019 (online)

Abstract

Background Objective of this study was to assess postoperative morbidity and mortality as well as recurrence-free and overall survival in patients with thymic malignancies and pleural dissemination undergoing surgical cytoreduction and hyperthermic intrathoracic chemotherapy (HITOC).

Methods Retrospective study between September 2008 and December 2017 with follow-up analysis in May 2018.

Results A total of 29 patients (male: n = 17) with thymic malignancies and pleural spread (primary stage IVa: n = 11; pleural recurrence: n = 18) were included. Surgical cytoreduction was performed via pleurectomy/decortication (P/D; n = 11), extended P/D (n = 15), and extrapleural pneumonectomy (EPP; n = 3). These procedures resulted in 25 (86%) patients with macroscopically complete (R0/R1) resection. Intraoperative HITOC was performed for 60 minutes at 42°C either with cisplatin (100 mg/m2 body surface area [BSA] n = 8; 150 mg/m2 BSA n = 6; 175 mg/m2 BSA n = 1) or with a combination of cisplatin (175 mg/m2 BSA)/doxorubicin (65 mg; n = 14). Postoperative complications occurred in nine patients (31%). Cytoprotective therapy resulted in lower postoperative creatinine levels (p = 0.036), and there was no need for temporary dialysis in these patients. The 90-day mortality rate was 3.4%, as one patient developed multiple organ failure. While recurrence-free 5-year survival was 54%, an overall 5-year survival rate of 80.1% was observed. Survival depended on histological subtype (p = 0.01).

Conclusion Surgical cytoreduction with HITOC is feasible in selected patients and offers encouraging survival rates. The application of cytoprotective agents appears to be effective for the prevention of postoperative renal insufficiency.