Expanded indications for transcervical thymectomy in the management of anterior mediastinal masses

Background. Transcervical thymectomy (TCT) is an accepted though controvers ial approach for thymectomy in myasthenia gravis (MG). The suggestion of th ymoma on computed tomography (CT) has been considered a contraindication to TCT. We sought to determine whether the indications for TCT could be safel y expanded to include selected patients with thymomas as well as other type s of anterior mediastinal masses. Methods. between January 1992 and September 1999, we performed 121 TCTs: 98 in patients with MG and 23 in patients without MG. The patients' records w ere retrospectively reviewed. Results. Among the 98 MG patients, 28 had CT scans suspicious for thymoma. Of these, 14 had a thymoma pathologically. These were classified as stage I (5), stage II (8), and stage III (1). Five patients required extension of the incision for completion of the procedure. There have been no thymoma re currences to date with a mean follow-up of 48 months (range 3 to 96 months) . In the 23 patients without MG, 12 had new anterior mediastinal masses, 4 had a history of treated lymphoma, 1 had a history of treated germ cell tum or, and lj had suspected mediastinal parathyroid adenoma. Diagnostic tissue was obtained in all patients undergoing the procedure for diagnosis, and i n 4 of 6 patients, a parathyroid adenoma was successfully resected. Conclusions. Transcervical exploration and thymectomy offers a less invasiv e approach to the diagnosis and/or definitive treatment of selected anterio r mediastinal masses. We suggest that it is appropriate to expand its use t o several clinical scenarios beyond the typical indication of thymectomy in MG patients without thymoma. (C) 2001 by The Society of Thoracic Surgeons.