Thymectomy or partial thymectomy, that is the question: surgical considerations for early-stage thymic epithelial tumors: a narrative review.

Abstract

Background and objective: According to the National Comprehensive Cancer Network (NCCN) and other international guidelines, thymectomy is the standard surgical procedure for early-stage thymic epithelial tumors (TETs). However, the optimal extent of resection remains controversial. Recent evidence suggests that partial thymectomy, which preserves part of the thymus, may achieve outcomes comparable to thymectomy in the short- and long-term. This review aims to compare perioperative and long-term oncologic outcomes between complete and partial thymectomy in early-stage TETs.

Methods: We conducted a PubMed search for English-language studies published from January 1, 1980, to July 31, 2025 that reported perioperative and long-term outcomes of patients with early-stage TETs who underwent either thymectomy or partial thymectomy.

Key content and findings: Initial single-institution retrospective studies with limited cases were followed by larger multicenter investigations, national database analyses, and two meta-analyses. Partial thymectomy was frequently associated with shorter operative time, less blood loss, and, in some studies, lower complication rates. Short-term survival outcomes were generally similar between the two procedures. Recurrence rates, disease-free survival, and overall survival (OS) were broadly comparable, although some studies indicated slightly better OS with thymectomy in certain subgroups.

Conclusions: Based on the currently available retrospective evidence, partial thymectomy may be feasible in carefully selected patients with early-stage thymoma; however, the lack of prospective data precludes definitive conclusions regarding oncologic equivalence. Most existing evidence is based on open approaches, particularly median sternotomy. Whether these findings extend to minimally invasive techniques such as video-assisted thoracoscopic surgery or robot-assisted thoracic surgery remains uncertain. Long-term data beyond 5 years are limited, and evidence regarding thymic malignancies other than thymoma is sparse. Further contemporary studies, particularly of minimally invasive approaches, are needed to clarify the relative benefits of partial thymectomy versus thymectomy.