Abstract
A 63-year-old woman was found to have an abnormal thoracic shadow at a regular health examination, and she was referred to our department. Thoracic computed tomography (CT) showed a tumor in the anterior mediastinum, with suspected invasion of the right lung, bilateral brachiocephalic veins, and superior vena cava, as well as pleural dissemination. Thymoma was diagnosed by CT-guided biopsy, and the decision was made to perform surgery. The operation was started with median sternotomy in the supine position, and after the thymus had been divided as far as possible, the bilateral brachiocephalic veins and superior vena cava were reconstructed with artificial graft, and the wound was closed. The patient was moved to the left lateral decubitus position, and the right upper and middle lobes of the lung were also resected via a 5th intercostal thoracotomy with an anteroaxillary incision and the lung, thymus, and tumor removed en bloc. Subsequently, the lesions of pleural disseminasion were also resected as far as possible. At present, 6 years after surgery, no recurrence of thymoma has been observed. Therefore, we consider surgery with the aim of total macroscopic resection to be an effective method for stage IVa thymoma.
