Surgery for thymic tumour

Authored by Andrea Billè, published on 2026-04-14 19:22:25.0

Stage-based management of thymic tumors, emphasizing complete surgical resection (via VATS/RATS or open thymectomy) for early stages, with increasing need for en bloc resection of involved structures as stage advances. For locally advanced or potentially unresectable disease, induction therapy is recommended to achieve resectability, while selected recurrent cases may still be considered for tailored surgical resection depending on site and extent.

  1. Surgery for thymic tumour
    • Stage IVB (not for surgery)
    • Stage IVA
      • Induction treatment
        • Thymectomy + pleurectomy +/- lung resection up to pneumonectomy
    • Stage IIIB
      • If resectable based on structure involved
        • Induction treatment
          • Extensive thymectomy with vascular resection and reconstruction
    • Stage IIIA (level 3 structures)
      • Unlikely completely resectable
        • Induction treatment
          • Extensive thymectomy with vascular resection and reconstruction
      • Likely resectable
        • Extensive thymectomy with vascular resection and reconstruction
    • Stage II
      • VATS/RATS thymectomy + resection of: lung; pericardium; phrenic nerve*
        • If phrenic nerve resected proceed with diaphragmatic plication
    • Stage I
      • VATS/RATS thymectomy
        • Tumour >7cm (higher risk to convert to open)
  2. Recurrent thymoma
    • Consider surgery
      • Pleura → pleurectomy
      • Lung → lung resection
      • Mediastinum → redo resection
tosprivacyNCCN Clinical Practice Guidelines in OncologyNCCN Thymomas and Thymic Carcinomas