Surgical Approaches and Extent of Resection for Non-myasthenic Thymic Epithelial Tumors:Current Evidence and Future Perspectives

Abstract

Thymic epithelial tumors are rare anterior mediastinal neoplasms that include thymoma, thymic carcinoma, and neuroendocrine tumors. Complete surgical resection remains the cornerstone of curative treatment;however, the optimal extent of thymectomy and surgical approach are still being debated. Advances in minimally invasive techniques, such as video-assisted thoracoscopic surgery and robot-assisted thoracoscopic surgery (RATS), have shifted practice away from traditional median sternotomy. Evidence consistently shows that complete resection is the most important prognostic factor across all subtypes. Regarding early-stage thymoma, multicenter and propensity score–matched studies showed that partial thymectomy may achieve similar oncologic outcomes to total thymectomy, with shorter hospital stays and reduced perioperative morbidity. Conversely, total thymectomy remains essential for thymic carcinoma or invasive disease. Minimally invasive approaches, particularly RATS, offer advantages including precise dissection in narrow mediastinal spaces, less blood loss, and faster recovery without compromising the margin status or long-term survival. Emerging data also suggest potential long-term immunological and oncologic consequences of total thymectomy in adults, underscoring the need for individualized surgical planning. Overall, current evidence supports tailoring the extent and approach of thymectomy according to the histological subtype, tumor stage, and patient factors, balancing oncologic radicality with the preservation of physiological thymic function. J. Med. Invest. 73 : 319-325, August, 2026