Thymus Cancer: Surgery
Surgery is often used to treat thymus tumors. Different kinds of surgery may be done. Which type you have depends on how much the cancer has spread, and other factors.
When might surgery be used for thymus tumors?
Surgery is normally the main treatment for thymus tumors if it can be done. The goal is to remove the tumor and the rest of the thymus. In some cases, you may need surgery for a diagnosis. Or you may just have it to treat the tumor.
Your healthcare provider may recommend surgery even if he or she doesn’t think all of the tumor can be removed. Here, the goal is to remove as much of the tumor as possible. This might help other treatments work better. Not all healthcare providers agree with this approach, though.
Types of surgery for thymus tumors
The main type of surgery for thymus tumors is called a thymectomy. This is when the tumor and the rest of your thymus is removed. If the tumor has reached nearby structures, such as the lining of your lung (pleura), lining around your heart (pericardium), or a lung, your healthcare provider may remove these as well.
This type of surgery is often done through a cut in the front of your chest and breastbone (sternum). This is called a median sternotomy. Less often, the surgery might be done through several small incisions. In these cases, your healthcare provider will use special long, thin surgical tools. But this approach should only be done at centers that have a lot of experience with this technique.
Possible risks, complications, and side effects of surgery
All surgery has risks. Some of the risks of any major surgery include:
Reactions to anesthesia
Blood clots in the legs or lungs
Damage to nearby organs
Risks from surgery for a thymus tumor
Along with the risks above, thymus tumor surgery can sometimes cause other problems. These can include:
Pneumonia. Some people have lung problems after surgery. This can lead to pneumonia.
Trouble breathing. This can be a problem if part or all of a lung is removed.
Getting ready for your surgery
Before you go for surgery, you’ll meet with your surgeon to talk about the procedure. At this time, you can ask any questions and discuss any concerns you may have. This is also a good time to review the side effects of the surgery and to talk about its risks. You might ask if the surgery will leave scars and what those scars will look like. You might also want to ask when you can expect to return to your normal activities. After you’ve discussed all the details with your surgeon, you will sign a consent form that says he or she can do the surgery.
A few days before your surgery, your healthcare provider might prescribe laxatives and enemas. These can help clean out your colon. Your healthcare provider will tell you when and how to use these. You may also be told to follow a special diet.
On the day of your surgery, you should arrive at the hospital admission area a couple of hours before the time your surgery is supposed to start. There, you'll complete the needed paperwork and then go to a preoperative area. In this area, you’ll undress and put on a hospital gown. During this time, your doctors and nurses will ask you about your medical history and medicine allergies. They’ll also talk about the surgical procedure. Try not to get frustrated by the repetition. These questions are repeated to help prevent mistakes.
While you’re in the preoperative area, an anesthesiologist or a nurse anesthetist will do an evaluation. He or she will also explain the anesthesia you will have during your surgery. The purpose of the anesthesia is to put you to sleep so that you won't feel any pain during the operation. Be sure to answer all the questions well and honestly. This will help prevent complications. Also, ask any questions you have about your anesthesia. You’ll have to sign a form that states that you understand the risks involved.
Your surgeon will also see you in the preoperative area. You can ask any last-minute questions you have. This will help put your mind at ease.
What to expect during surgery
When it’s time for your surgery, you’ll be taken into the operating room. There will be many people there. This includes the anesthesiologist, surgeon, and nurses. To ensure sterility, everyone will wear a surgical gown and a face mask. Once you’re in the room, medical staff will move you onto the operating table. There, your anesthesiologist or nurse will place an intravenous line (IV) into your arm. This requires just a small skin prick. (Sometimes the IV may be started in the preoperative area instead.) Someone may place special stockings on your legs to help prevent blood clots. Electrocardiogram (EKG) wires with small, sticky pads on the end will be attached to your chest to monitor your heart. A blood pressure cuff will be wrapped around your arm. When all the preparation is done, you’ll receive the anesthetic through the IV. Then you will fall asleep.
During surgery, a Foley catheter may be placed through your urethra and into your bladder. This is a hollow tube used to drain urine. You’ll also have a breathing tube placed in your windpipe. A breathing machine (ventilator) will control your breathing. Also, a nasogastric tube may be placed in your nose. This is a suction tube that extends into your stomach to drain its contents.
What is removed during surgery and where your incisions are depend on the type of surgery you have. This is based on where the tumor is.
After your surgery is done, medical staff will move you to the recovery room. There, they will monitor you for another hour or two. When you wake up, don't be alarmed by the number of tubes and wires attached to you. These are normal postoperative monitors. When you’re fully awake in the recovery room, your family will be able to see you for a short time. Once you’re awake and stabilized, the staff will move you to the regular hospital floor.
What to expect after surgery
When you first wake up, you might have some pain. Your healthcare provider will give you pain relievers as needed to help you feel more comfortable. The pain medicines will also help you get up and walk the day after your surgery. This is important for your recovery.
It will take you time to get back to eating normally and having regular bowel movements. You will still have the Foley catheter in your bladder to drain urine. It allows your healthcare providers to measure your urine output. This helps to keep track of your fluid status. It’s normally taken out before you go home.
You’ll likely need to stay in the hospital for several days. You can slowly return to most normal activities once you leave the hospital. But you should avoid lifting heavy things for several weeks. Always follow the instructions you get from your healthcare team.
After surgery, you may feel weak or tired for a while. The amount of time it takes to heal from an operation is different for each person. But you may not feel like yourself for several months. Your healthcare provider will give you instructions about whether and when you can get your incisions wet. You likely won't be able to drive for a while, as directed by your healthcare providers.
Talk to your healthcare team
If you have any questions about your operation, be sure to talk to your healthcare team. They can help you know what to expect before, during, and after your surgery.
March 21, 2017
Clinical Presentation and Management of Thymoma and Thymic Carcinoma. UpToDate.
Alteri, Rick, MD,Gersten, Todd, MD