Management of Thymic Tumors A Survey of Current Practice among Members of the European Society of Thoracic Surgeons

Introduction: Management of thymoma has largely been based on single-institution retrospective, observational studies. The European Society of Thoracic Surgeons (ESTS) Thymic Working Group has investigated the current practice among ESTS members. Methods: A questionnaire divided into seven sections with 24 questions was designed, and it was delivered to ESTS members. Results: Forty-four centers replied to the questionnaire. The results indicate that there is a general agreement concerning (1) the value of computed tomography scan for preoperative assessment; (2) the uselessness of a routine histologic confirmation before surgery; (3) the role of the World Health Organization classification; (4) the importance of complete and extended resection; (5) the role of surgery for recurrent disease; and (6) the need of a multidisciplinary team, including thoracic surgeons, pathologists, medical, and radiation oncologists. On the other hand, there is still a considerable debate about (1) the role of positron emission tomography scan for preoperative assessment; (2) a consistent and reliable staging system; (3) the usefulness of postoperative treatments for stages II and III diseases; (4) the management of type C thymoma; and (5) the role of extrapleural pneumonectomy for stage IVA thymoma. Conclusions: The survey provides a large, multiinstitutional overview of the clinical practice in the management of thymic tumors by ESTS members. Responses show some areas of agreement along with several areas of controversy. It is conceivable that a consequent step forward will be the creation of a collaborative effort within the ESTS and with other organizations for the creation of standard recommendations and guidelines for the management of thymic malignancies.