Surgery for Thymus Cancer

Whenever possible, surgery is used to treat thymus tumors (thymomas and thymic carcinomas). If you have a thymus tumor, one of the first things your doctor will do is use imaging tests to determine if it can be completely removed (resected) with surgery.

The goal of thymus surgery

The goal of surgery for thymus cancer is to remove the whole tumor. The most common surgery is to completely remove the thymus. This is called a thymectomy. The surgeon will also try to remove any areas of tumor that have spread outside of the thymus. If the tumor has grown into nearby structures, parts of those structures also might need to be removed. This could mean removing parts of the pleura (the outer lining of the lung), pericardium (the sac surrounding the heart), nerves, the superior vena cava (a large vein leading to the heart), and/or lung.

The surgeon will also remove nearby lymph nodes so they can be checked for cancer.

How surgery is done to remove thymus cancer

Surgery to remove the thymus (thymectomy) can be done in a few different ways. During any of these types of surgery, the surgeon will also remove nearby lymph nodes so they can be checked for cancer.

Open thymectomy

The traditional approach is through a long incision (cut) down the middle of the chest that splits the sternum (breastbone). This is a type of open surgery, where the surgeon operates through a large incision. This approach is called a median sternotomy.

Minimally invasive thymectomy

For smaller thymus tumors, some surgeons do a minimally invasive thymectomy (MIT). During minimally invasive surgery, the surgeon makes smaller incisions and uses long, thin surgical tools, including one with a tiny video camera on the end, to reach the tumor. The surgeon can hold the tools directly. This is called video-assisted thoracoscopic surgery (VATS). Or the surgeon can sit at a control panel and guide robotic arms. This is called robotic-assisted thoracoscopic surgery (RATS).

Both VATS and RATS typically cause less pain and have a faster recovery than open surgery. But the surgeon has less room to work, so not every tumor can be removed this way. Larger tumors, or those that have grown into nearby tissue, usually still require open surgery.

Researchers are still studying how MIT compares to open surgery over the long term. They are trying to find out whether the cancer is more likely to come back. Some studies have found no real difference, while others suggest open surgery may offer better long-term cancer control. Surgeons continue to work on improving these techniques and finding out who MIT is best for.

Chemotherapy before surgery

Sometimes, chemotherapy may be given before surgery to try to shrink the tumor so it can be more easily and completely removed. This is known as neoadjuvant therapy.

If cancer has spread to the lung

If the cancer has spread to the lung, you may need to have part or all of a lung removed. If your lungs were otherwise healthy before surgery, you can usually return to your normal activities afterward. If you already have lung problems, such as emphysema or chronic bronchitis, you may notice more shortness of breath with activity after surgery. These conditions are more common among people who smoke heavily,

Complications of surgery

Possible complications depend on the extent of the surgery and on your health beforehand. Serious problems can include:

• Excess bleeding
• Infection at the incision site
• Serious lung problems, including pneumonia or a collapsed lung
• Damage to important nerves near the thymus, including the phrenic nerve, which controls the diaphragm and breathing

Doctors usually screen for myasthenia gravis with blood tests before surgery. People with myasthenia gravis may experience a flare-up of muscle weakness right after surgery, called a myasthenic crisis. This may be prevented with medicines. 

You will most likely need to stay in the hospital for several days after surgery. If you had open surgery, the incision area will likely be sore for some time. Plan to limit your activity for at least a month or two.

More information about surgery

For more general information about surgery as a treatment for cancer, see Cancer Surgery.

To learn about some of the side effects listed here and how to manage them, see Managing Cancer-related Side Effects.