Mediastinum (Hong Kong, China)最新文献

{"title":"Acute mediastinitis, mediastinal granuloma, and fibrosing mediastinitis: a narrative review.","authors":"Christopher R VanDreumel, Richard G Johnson, Bilal Zafar, Daniel Ocazionez, Rosa M Estrada-Y-Martin, Sujith V Cherian","doi":"10.21037/med-2026-1-0003","DOIUrl":"10.21037/med-2026-1-0003","url":null,"abstract":"<p><strong>Background and objective: </strong>Acute mediastinitis, mediastinal granuloma (MG), and chronic fibrosing mediastinitis (FM) are distinct disease processes affecting the mediastinal structures. These diseases have variable etiologies, management strategies, and outcomes. The purpose of the manuscript is to present a narrative review of these distinct, albeit rare conditions affecting the mediastinum.</p><p><strong>Methods: </strong>We searched various databases such as PubMed and Google Scholar from the last 10 years for the various benign mediastinal disorders we wanted to discuss. Relevant articles that were written in English were shortlisted and used to help write this narrative review.</p><p><strong>Key content and findings: </strong>The most common causes of acute mediastinitis are post-operative infection, esophageal perforation, or deep neck space infection originating from the oropharynx. Acute mediastinitis is a life-threatening disease, is difficult to manage and is associated with high morbidity and mortality. MG is usually a sequela of chronic infection or inflammation that has an overall benign course and the possibility of spontaneous resolution. On occasion, an MG can cause pathophysiological consequences due to its mass effect. FM is caused by infectious, inflammatory, or malignant conditions and can also be idiopathic. This condition leads to extensive fibrosis throughout the mediastinum with invasion of mediastinal structures. It is difficult to treat, especially when complications arise from invasion or compression of mediastinal structures, and it carries a poor prognosis.</p><p><strong>Conclusions: </strong>In this review article, we will discuss each of these conditions in more detail, including epidemiology, pathophysiology, clinical features, imaging features, diagnosis, management, and prognosis.</p>","PeriodicalId":74139,"journal":{"name":"Mediastinum (Hong Kong, China)","volume":"10 ","pages":"25"},"PeriodicalIF":0.0,"publicationDate":"2026-06-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13346024/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148427149","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Approach to mediastinal cytopathology: a diagnostic overview.","authors":"Ryan Reagans, Zaibo Li","doi":"10.21037/med-2025-1-58","DOIUrl":"10.21037/med-2025-1-58","url":null,"abstract":"<p><p>The mediastinum contains a diverse array of tissues, giving rise to a wide spectrum of benign, inflammatory, and malignant lesions. Accurate diagnosis is essential for determining appropriate management strategies, ranging from observation to targeted therapy. Fine-needle aspiration (FNA) has become the cornerstone of mediastinal evaluation, particularly with the advent of endobronchial and endoscopic ultrasound-guided techniques [endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) and endoscopic ultrasound-guided FNA (EUS-FNA)], which allow minimally invasive access to all mediastinal compartments. Cytologic evaluation of these specimens, however, presents diagnostic challenges due to overlapping morphologic features and limited material for ancillary testing. This comprehensive review outlines a systematic approach to mediastinal cytopathology, emphasizing specimen adequacy, cytomorphologic interpretation, and integration with ancillary studies. Key entities include reactive lymphoid hyperplasia, granulomatous inflammation, cystic lesions, and a range of neoplastic processes such as thymic epithelial tumors, lymphomas, germ cell tumors (GCTs), mesenchymal neoplasms, and metastatic malignancies. Ancillary techniques-immunocytochemistry (ICC), flow cytometry, and molecular testing-play pivotal roles in confirming lineage, assessing clonality, and enabling targeted therapeutic decisions. Advances in next-generation sequencing (NGS) have expanded the use of cytology specimens for molecular profiling, while digital cytology and artificial intelligence (AI) are emerging as promising tools to improve accuracy and reproducibility. The review also highlights common diagnostic pitfalls, including confusion between thymic lesions and metastatic carcinoma, lymphoma and thymoma, or GCTs and poorly differentiated carcinomas. An algorithmic diagnostic workflow that combines cytomorphology with clinical, radiologic, and molecular data enhances accuracy and efficiency.</p>","PeriodicalId":74139,"journal":{"name":"Mediastinum (Hong Kong, China)","volume":"10 ","pages":"21"},"PeriodicalIF":0.0,"publicationDate":"2026-06-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13346008/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148427169","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Mediastinitis after cardiac surgery, from microbes to management: a systematic review.","authors":"Aryan Shah, Riccardo Romagnoli, Nitish Dhingra, Rajeev Thilak, Robert Cusimano","doi":"10.21037/med-2025-1-75","DOIUrl":"10.21037/med-2025-1-75","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Post-sternotomy mediastinitis is a complication of cardiac surgery associated with substantial morbidity, mortality, and healthcare burden. Despite advances in surgical technique, perioperative care, and infection control, patient risk profiles and surveillance methodologies continue to drive variation in reported incidence rates. The objective of this systematic review is to review the evidence on incidence, microbiology, risk factors, prevention, and management of mediastinitis after cardiac surgery.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;A systematic search of Ovid MEDLINE and EMBASE was performed from inception to October 2025 following PRISMA 2020 guidelines (registration CRD420251177438). Eligible studies included adult patients undergoing cardiac surgery with reported outcomes on mediastinitis incidence, mortality, microbiology, prevention, or management. Case reports, conference abstracts, and narrative reviews were excluded. Data were extracted on study design, population characteristics, pathogen distribution, preventive strategies, and management approaches. Due to heterogeneity in study designs and outcome definitions, a meta-analysis was not performed.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;60 studies met inclusion criteria. Across over 400,000 patients, the reported incidence of mediastinitis ranged from 0.2% to 11.0%, with contemporary series typically reporting 0.5-3%. Mortality ranged from 1.5% in contemporary early-treated cohorts to 40-60% in delayed, recurrent, or fungal mediastinitis complicated by sepsis. &lt;i&gt;Staphylococcus aureus&lt;/i&gt; and coagulase-negative &lt;i&gt;staphylococci&lt;/i&gt; (CoNS) remained predominant pathogens, alongside methicillin-resistant strains, gram-negative bacilli, and an emerging burden of fungal and biofilm-forming organisms. Consistent risk factors included diabetes, obesity, chronic kidney disease, chronic lung disease, prolonged cardiopulmonary bypass, bilateral internal thoracic artery (BITA) harvest, high transfusion burden, and re-exploration. Preventive strategies included well-timed, weight-adjusted antibiotic prophylaxis, optimized perioperative glycemic control, skeletonized internal thoracic artery harvest, rigid sternal fixation in high-risk patients, and closed-incision negative-pressure therapy. Effective management involved early radical debridement, vacuum-assisted closure therapy, culture-directed antimicrobials, and vascularized flap coverage within multidisciplinary teams.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;Post-sternotomy mediastinitis remains a preventable systemic complication. Bundled perioperative strategies, meticulous sternal technique, optimized perfusion and metabolic control, and coordinated multidisciplinary management offer the greatest potential to reduce incidence and improve outcomes. Future research should standardize definitions, refine prophylaxis bundles, optimize antimicrobial duration, and integrate advanced diagnostics for early detection of biofilm-m","PeriodicalId":74139,"journal":{"name":"Mediastinum (Hong Kong, China)","volume":"10 ","pages":"23"},"PeriodicalIF":0.0,"publicationDate":"2026-06-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13346027/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148427132","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Mediastinal epithelial neoplasms with recurrent molecular alterations.","authors":"Michael W Mikula, Ezra Baraban","doi":"10.21037/med-2025-1-76","DOIUrl":"10.21037/med-2025-1-76","url":null,"abstract":"<p><p>A wide variety of benign and malignant epithelial tumors arise in the mediastinum. This review sheds light on recurrent molecular genetic alterations of mediastinal epithelial tumors to help the surgical pathologist become aware of molecularly defined entities that one may encounter in practice and understand relevant genetic underpinnings, with an emphasis on diagnostically useful immunohistochemical targets. We discuss the molecular landscape of thymoma, including World Health Organization (WHO) types as well as micronodular and metaplastic thymoma, and introduce current concepts in the molecular subtyping of thymic carcinoma. We present an overview of proposed molecular classification schemes of thymic epithelial neoplasms that focuses on commonly occurring molecular alterations described in The Cancer Genome Atlas and original data sources, and relate them to longitudinal prognostic and therapeutic implications. Poorly differentiated epithelial neoplasms of the mediastinum defined by recurrent molecular alterations can display diagnostically challenging morphologic and immunohistochemical profiles and are critically important to recognize due to their aggressive behavior. We conclude with a discussion of NUT carcinoma and switch/sucrose non-fermentable (SWI/SNF) complex deficient tumors, including thoracic SMARCA4-deficient undifferentiated tumor, reviewing salient histopathologic and immunohistochemical features that allow their recognition from histologic mimics and tumors with overlapping immunoprofiles. We lastly outline the current understanding of genetic events that give rise to these destructive tumors.</p>","PeriodicalId":74139,"journal":{"name":"Mediastinum (Hong Kong, China)","volume":"10 ","pages":"27"},"PeriodicalIF":0.0,"publicationDate":"2026-06-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13346009/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148427120","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Pathobiology of thymic epithelial tumours and the treatment strategy based on immuno-oncological characteristics: a narrative review.","authors":"Satoru Okada, Shunta Ishihara, Tatsuo Furuya, Chiaki Nakazono, Masayoshi Inoue","doi":"10.21037/med-2025-1-72","DOIUrl":"10.21037/med-2025-1-72","url":null,"abstract":"<p><strong>Background and objective: </strong>Thymic epithelial tumours (TETs), including thymomas and thymic carcinomas, are relatively rare anterior mediastinal malignancies. Thymomas are well known to be associated with various autoimmune diseases, such as myasthenia gravis (MG), pure red cell aplasia, and hypogammaglobulinemia. The mainstay of treatment for all TETs is complete surgical resection, although recent advances in irradiation and anti-tumour drug therapies are increasingly indicated for advanced or recurrent disease. The pathobiology of TETs was reviewed to consider optimal treatment strategies based on their immuno-oncological characteristics.</p><p><strong>Methods: </strong>A comprehensive literature search was conducted using PubMed, focusing on the biology and treatment of TETs, along with integration of our original research data.</p><p><strong>Key content and findings: </strong>Pathobiology is different between thymoma and thymic carcinoma. Incomplete T cell development is observed in thymoma, which may affect patient autoimmunity. Type AB, B1, and B2 thymomas harbour abundant immature T cells, which cannot act as effector T cells in treatment using immune checkpoint inhibitors (ICIs). Neoplastic thymic epithelial cells (TECs) express programmed cell death-ligand 1 (PD-L1) at varying levels, and frequent genetic aberrations are observed according to the World Health Organization (WHO) classification. Germinal centre formation in the surrounding thymus may have a clinical role in thymoma-associated MG. Regarding treatment strategies, radical minimally invasive thymectomy using robotic technology is now available for MG. Effective molecular-targeted and ICI therapies have recently been introduced, and further novel targeted therapies are currently under development. WHO histological subtypes and inflammatory biomarkers are practically useful for determining the treatment strategy.</p><p><strong>Conclusions: </strong>A fundamental understanding of pathobiology and immuno-oncology is crucial for the appropriate management of TETs.</p>","PeriodicalId":74139,"journal":{"name":"Mediastinum (Hong Kong, China)","volume":"10 ","pages":"17"},"PeriodicalIF":0.0,"publicationDate":"2026-06-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13346031/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148426630","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Narrative review of descending necrotizing mediastinitis, focusing on the etiology, classification-guided surgical management, treatments, and prognosis.","authors":"Kosuke Kamada, Tatsuro Okamoto, Atsushi Osoegawa, Kenji Sugio","doi":"10.21037/med-2025-1-46","DOIUrl":"10.21037/med-2025-1-46","url":null,"abstract":"<p><strong>Background and objective: </strong>Descending necrotizing mediastinitis (DNM) is a rare, life-threatening infection characterized by the rapid spread of deep neck infection (DNI) along the continuous fascial planes into the mediastinum. Although diagnostic and therapeutic advances have improved patient outcomes, the prognosis remains unsatisfactory in advanced cases or in the absence of timely and appropriate treatment, mainly due to delayed diagnoses and difficulty in selecting an appropriate surgical approach. This review summarizes the current knowledge on the pathophysiology, anatomical classification, and surgical treatment of DNM, with particular emphasis on a recently proposed classification for surgical planning.</p><p><strong>Methods: </strong>A literature search was conducted using PubMed/MEDLINE for the period from January 1999 to June 2025 with the term \"descending necrotizing mediastinitis\". Full texts were retrieved through the Oita University Library. No restrictions were placed on article type. Eligible studies were English-language reports (written in English at least in abstract) addressing the etiology, pathophysiology, anatomical classification, surgical approach and treatment, or outcome of DNM. Conference proceedings and animal experimental studies were excluded. For quantitative tabulations, only articles reporting ≥4 patients were included, and less than 4 patients case-reports were excluded from the quantitative summaries.</p><p><strong>Key content and findings: </strong>Over time, disease classification has become more common, and the proportion of Type I disease has been increasing, reflecting improvements in the early diagnosis. Mortality rates have improved from 24.7% in the 2000s to 17.8% in the 2010s and to 14.1% in the 2020s, in our descriptive rates derived from registry cohorts. Type II disease extending below the carina, is associated with worse outcomes than Type I disease. In particular, Type IIC disease descending through the retrovisceral space, is often unsuitable for traditional anterior approaches and requires a posterior mediastinal approach via video-assisted thoracic surgery (VATS). Optimal outcomes depend on a multidisciplinary treatment strategy that includes early airway management, broad-spectrum antimicrobial therapy, and precise targeted surgical drainage.</p><p><strong>Conclusions: </strong>Improved treatment outcomes for DNM require a rapid diagnosis, accurate anatomical assessment, and prompt, case-appropriate surgical intervention. Recognizing the correct classification enables the selection of the most suitable drainage approach and is expected to further improve the prognosis.</p>","PeriodicalId":74139,"journal":{"name":"Mediastinum (Hong Kong, China)","volume":"10 ","pages":"18"},"PeriodicalIF":0.0,"publicationDate":"2026-06-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13346026/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148426396","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Salvage resection via a trans-manubrial approach after definitive chemoradiotherapy for initially unresectable thymic carcinoma in the superior mediastinum: a case report.","authors":"Shinya Hirota, Masatsugu Hamaji","doi":"10.21037/med-2025-1-69","DOIUrl":"10.21037/med-2025-1-69","url":null,"abstract":"<p><strong>Background: </strong>Initially unresectable thymic carcinoma poses significant management challenges, and the role of salvage resection after definitive chemoradiotherapy has limited evidence.</p><p><strong>Case description: </strong>We report a successful case of complete salvage resection via a trans-manubrial approach. A 48-year-old man presented with hoarseness and was diagnosed with thymic squamous cell carcinoma originating from the superior mediastinum, invading the aortic arch and arch vessels, and metastasizing to a left supraclavicular lymph node (LN; T4N2M0). He underwent definitive chemoradiotherapy with two cycles of carboplatin and nab-paclitaxel with 60 Gy, resulting in a partial response (PR) on computed tomography. For presumed residual disease, salvage surgery was performed. A left-sided trans-manubrial approach was selected to allow safe exposure of the superior mediastinum and potential control of the aortic arch vessels. Intraoperative findings showed no macroscopic invasion of the aortic arch, trachea, or esophagus. The postoperative course was uneventful. Histopathological examination of the entire tumor bed revealed no residual viable tumor cells, indicating a pathological complete response.</p><p><strong>Conclusions: </strong>Salvage resection after chemoradiotherapy for initially unresectable thymic carcinoma may be feasible and potentially curative in carefully selected patients. This case highlights both the usefulness of a trans-manubrial approach for superior mediastinal lesions and the challenges in accurately assessing a residual disease after chemoradiotherapy.</p>","PeriodicalId":74139,"journal":{"name":"Mediastinum (Hong Kong, China)","volume":"10 ","pages":"29"},"PeriodicalIF":0.0,"publicationDate":"2026-06-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13346028/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148426623","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Aberrant malignant invasive thymoma presenting as isolated left internal jugular vein thrombosis.and resected by VATS thymectomy: a case report.","authors":"Agasthian Thirugnanam","doi":"10.21037/med-2025-1-62","DOIUrl":"10.21037/med-2025-1-62","url":null,"abstract":"<p><strong>Background: </strong>Though superior vena cava (SVC) syndrome due to local invasion by malignant thymoma has been well described in the literature, isolated local obstruction of the internal jugular vein with venous thrombosis has not been reported previously. Though SVC thrombosis has been frequently reported previously, this is the first reported case of isolated jugular vein thrombosis due to compression by an aberrant thymoma arising from an anomalous accessory thymus located behind the innominate vein.</p><p><strong>Case description: </strong>Patient is a 51-year-old male who noticed prominent left neck veins of 1-month duration. Ultrasound of neck veins revealed left internal jugular vein thrombosis. Computed tomography (CT) scan of neck and thorax showed a 5 cm thymoma arising from an anomalous left lobe located behind the left innominate vein and compressing the internal jugular-subclavian vein junction. Internal jugular vein thrombosis resolved after 1 week of anticoagulant therapy. Preoperative assessment showed no evidence of myasthenia gravis (MG) or other paraneoplastic syndromes. Patient underwent a left video-assisted thoracoscopic surgery (VATS) thymectomy. Intraoperative findings showed a locally invasive malignant thymoma arising from an anomalous left lobe of the thymus behind the left innominate vein. There was no local invasion of the vein, but mechanical compression of the innominate vein, internal jugular vein junction by the tumour, causing venous thrombosis. VATS radical thymectomy was done. Postoperative recovery was uneventful. Final histology showed a stage 3 World Health Organisation (WHO) Type B2 thymoma. Postoperative mediastinal radiotherapy was given. Follow-up CT scan thorax, done 1 year post-surgery shows no tumour recurrence.</p><p><strong>Conclusions: </strong>Malignant thymoma arising from an aberrant accessory left lobe behind the innominate vein can present as isolated internal jugular vein thrombosis. It can be resected safely by a \"no-touch, tumour last\" VATS oncological technique.</p>","PeriodicalId":74139,"journal":{"name":"Mediastinum (Hong Kong, China)","volume":"10 ","pages":"30"},"PeriodicalIF":0.0,"publicationDate":"2026-06-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13346005/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148427036","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The expanding role of robotic surgery in thymectomy: a narrative review.","authors":"Jun Yamaguchi, Kohei Hashimoto","doi":"10.21037/med-2025-1-67","DOIUrl":"10.21037/med-2025-1-67","url":null,"abstract":"<p><strong>Background and objective: </strong>Surgical resection for thymic epithelial tumors has traditionally been performed via a median sternotomy or video-assisted thoracoscopic surgery (VATS). In recent years, however, robot-assisted thoracoscopic surgery (RATS) has been increasingly adopted as a minimally invasive alternative, with a growing number of reports. This review summarizes the progress achieved to date and outlines future perspectives in robot-assisted thymectomy.</p><p><strong>Methods: </strong>This narrative review was conducted through a structured literature search of PubMed, including articles published up to November 2025. The search strategy combined the terms (\"thymectomy\"[MeSH] OR thymectomy) AND (\"video-assisted thoracoscopic surgery\" OR VATS OR \"robot-assisted thoracoscopic surgery\" OR RATS OR \"robotic surgery\"). Eligible articles included original clinical studies, comparative analyses, large case series, and selected case reports evaluating robotic approaches to thymectomy. Both retrospective and prospective studies were considered. Non-English-language publications were excluded. Reference lists of relevant articles were also manually screened to identify additional pertinent studies. Given the narrative nature of this review, no formal meta-analysis was performed.</p><p><strong>Key content and findings: </strong>This review traces the evolution of robotic surgery in thymectomy, evaluates current evidence regarding indications and perioperative/oncologic outcomes, and examines the expanding array of surgical approaches enabled by contemporary robotic platforms. It also highlights emerging technologies and future directions that may shape the continued advancement of robotic thymectomy. By integrating these themes, the review synthesizes the existing evidence base and provides a framework for anticipating the future trajectory of this technique.</p><p><strong>Conclusions: </strong>Accumulating evidence on robot-assisted thymectomy suggests that further innovations and refinements in surgical techniques will continue to emerge. As the technology evolves and surgical expertise deepens, these advancements are expected not only to enhance operative precision and safety but also to broaden the indications of the robotic approach, potentially allowing its application to more extensive and complex procedures in the future.</p>","PeriodicalId":74139,"journal":{"name":"Mediastinum (Hong Kong, China)","volume":"10 ","pages":"22"},"PeriodicalIF":0.0,"publicationDate":"2026-06-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13346006/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148427090","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A real-world cohort study comparing chemotherapy and surgery in the treatment of stage IVA thymomas with pleural dissemination.","authors":"Xuefei Zhang, Changlu Wang, Zhitao Gu, Qin Zhang, Lanting Gao, Xiuxiu Hao, Fenghao Yu, Ning Xu, Yan Shen, Lei Zhu, Xiaolong Fu, Teng Mao, Wentao Fang","doi":"10.21037/med-2025-1-73","DOIUrl":"10.21037/med-2025-1-73","url":null,"abstract":"<p><strong>Background: </strong>Chemotherapy is the guideline-recommended first-line therapy for stage IVA thymomas (TMs) with pleural dissemination, but its efficacy has never been specifically assessed. We aim to evaluate the efficacy of chemotherapy, and to compare the results of surgery and chemotherapy without surgery in these patients.</p><p><strong>Methods: </strong>This is a real-world retrospective study. Consecutive patients with stage IVA TM with pleural dissemination who received chemotherapy or upfront surgery between 2007 and 2018 were enrolled. Propensity-score matching (PSM) was used to balance selection bias between groups. Objective response rate (ORR) in pleural lesions to chemotherapy and long-term outcomes including disease-control time (DCT), progression-free survival (PFS) and overall survival (OS) were assessed between groups.</p><p><strong>Results: </strong>Altogether 168 patients with stage IVA TM with pleural dissemination were enrolled. In 124 patients who received chemotherapy as the first-line treatment, ORR was only 6.5% with no complete remission observed, with 7.3% progression diseases. After PSM, surgery was associated with better prognosis than no-surgery [median DCT: 39.0 <i>vs.</i> 23.0 months, P<0.001; PFS, hazard ratio (HR): 0.457, 95% confidence interval (CI): 0.298-0.700, P<0.001; OS, HR: 0.402, 95% CI: 0.178-0.906, P=0.03]. Significantly more patients received surgery in the later [2016-2018] than in the earlier [2007-2015] time of the study period (72.9% <i>vs.</i> 44.4%, P<0.001), while Bayesian analysis indicated a probability of 94.23% that this shift in treatment was associated with improved PFS.</p><p><strong>Conclusions: </strong>Chemotherapy as the first-line treatment is far from satisfactory for stage IVA TMs with pleural dissemination and may not be appropriate as a routine recommendation. Surgery plays a more important role as an alternative option.</p>","PeriodicalId":74139,"journal":{"name":"Mediastinum (Hong Kong, China)","volume":"10 ","pages":"16"},"PeriodicalIF":0.0,"publicationDate":"2026-03-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13346007/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148427049","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}