Tumeurs thymiques : prise en charge chirurgicale

Abstract

Thymic epithelial tumors (TETs) belong to rare orphan disease, nevertheless, they represent the most frequent anterior mediastinum tumors. Two distinguables entities are identified by the WHO classification: (1) thymomas, respecting the normal architecture of the gland and composed by tumoral epithelial cells associated with normal lymphocytes and (2) thymic carcinomas. TETS are frequently associated, in 30%, with paraneoplastic syndrome's, including in most of cases myasthenia gravis with anti acetylcholin receptor antibodies (RACH).The Masaoka-Koga classification, ITMIG modified in 2012 governs the principles of treatment. A multidisciplinary approach including thoracic oncologist, radiotherapist and thoracic surgeons is the standard of care and complex cases must be discussed in the French national network (RYTHMIC, thymic tumors and cancers, INCa labialized in 2012) within expert centers. The evident principle of care includes: a close evaluation of resectability, when feasible a surgical resection R0 (corner stone of a multimodal standard of care) non/or associated with neoadjuvant or adjuvant chemotherapies (CAP and carbo-taxol based) and radiotherapy.