Surgery for thymus cancer

Surgery is a medical procedure to examine, remove or repair tissue. Surgery, as a treatment for cancer, means removing the tumour or cancerous tissue from your body.

Most people with thymus cancer will have surgery. The type of surgery you have depends mainly on the stage and location of the cancer. When planning surgery, your healthcare team will also consider other factors, such as your overall health and if it’s safe for you to have surgery.

Surgery may be done for different reasons. You may have surgery to:

• completely remove the tumour
• remove as much of the tumour as possible before other treatments (called debulking surgery)
• reduce pain or ease symptoms (called palliative surgery)
• treat cancer that has come back (recurred) after other treatments

Surgery for thymus cancer is usually done by a thoracic surgeon, who is a doctor that specializes in surgery of the chest.

The following types of surgery are used to treat thymus cancer. You may also have other treatments before or after surgery.

A total thymectomy completely removes the thymus. Any cancer that has grown into tissue around the thymus is removed at the same time as the thymus (also called an en bloc resection or an extended thymectomy). This is often done if the person with thymus cancer also has myasthenia gravis.

A total thymectomy is done using one of the following surgical approaches – a median sternotomy, a bilateral anterolateral thoracotomy with transverse sternotomy or a thoracoscopy.

A median sternotomy is done using a general anesthetic (you will be asleep). The surgeon makes a cut (incision) in the skin over the breastbone (sternum) in the middle of the chest. The breastbone is split in half down the middle with a special saw so the surgeon can reach the thymus and remove it.

Flexible chest tubes, which are connected to bottles outside the body, are placed into the chest cavity. These tubes are used to drain blood, other fluids and air from the space around the lungs after surgery. They are left in place until x-rays show that the blood, fluids and air have been drained and the lungs can fully expand.

After surgery is done and chest tubes are in place, the surgeon wires the breastbone back together and closes the cut in the chest with stitches.

You usually need to stay in the hospital for several days after a median sternotomy.

A bilateral anterolateral thoracotomy with transverse sternotomy is also called a clamshell incision. It may be done if the cancer has spread throughout the lower part of the mediastinum.

This surgery is done using a general anesthetic. The surgeon makes 2 small cuts between the ribs on each side of the chest. These small cuts are connected by one larger cut just under the breasts. The breastbone is cut with scissors or a saw across the middle. Then the ribs are spread apart using a special tool (called a retractor) so the surgeon can reach the tumour.

Chest tubes are put in the chest cavity to drain blood, other fluids and air from the space around the lungs after surgery. They are left in place until x-rays show that the blood, fluids and air have been drained and the lungs can fully expand.

After surgery is done and chest tubes are in place, the surgeon removes the retractor and wires the breastbone back together. The cut in the chest is closed with stitches.

You usually need to stay in the hospital for several days after a bilateral anterolateral thoracotomy with transverse sternotomy.

A thoracoscopy is a less invasive way of removing the thymus for early stages of thymus cancer. It is done using a thoracoscope (a type of endoscope) and surgical tools that are inserted through small cuts on one or both sides of the chest between the ribs. The thoracoscope may have a small video camera attached to it (called video-assisted thoracic surgery, or VATS).

Find out more about a thoracoscopy.

Debulking surgery removes as much of the cancer as possible. This surgery may be used for advanced thymus cancer to help reduce the symptoms caused by growth of the tumour. Your healthcare team will decide if debulking surgery is a treatment option for you.

Side effects can happen with any type of treatment for thymus cancer, but everyone’s experience is different. Some people have many side effects. Other people have only a few side effects.

If you develop side effects, they can happen at any time during, immediately after, or a few days or weeks after surgery. Sometimes, late side effects develop months or years after surgery. Most side effects will go away on their own or can be treated, but some may last a long time or become permanent.

Side effects of surgery will depend mainly on the type of surgery and your overall health.

Surgery for thymus cancer may cause these side effects:

• pain
• wound infection
• bleeding
• irregular heart rate
• lung problems
• damage to the nerves in the diaphragm

Find out more about surgery and the side effects of surgery. To make the decisions that are right for you, ask your healthcare team questions about surgery.