Wind of change in surgical treatment of thymic tumors

Thymic tumors are a rare entity with a peculiar behavior ranging from indolent neoplasms to aggressive cancers (1). Complete surgical resection is advocated as the gold standard when feasible (2); chemotherapy and radiotherapy can be administered as an induction at advanced stages unsuitable for complete resection (3) or as adjuvant treatment in case of advanced pathological stages, aggressive histologies (3,4) or R+ resection. For a long time, because of the median position of the thymus within the mediastinum, the resection of thymic tumors has been almost always performed through a median access (complete sternotomy, sternal split, cervicotomy) and, in exceptional cases, by clamshell or combined incisions. Thymectomy included complete removal of thymus and the perithymic tissue. During the last ten years, due technological improvements, new trends in surgical management of thymic tumors have been proposed; particularly, the impressive impulse towards minimally invasive surgery is worldwide changing the historical dogmas concerning thymic surgery