einstein (São Paulo). 25/jun/2024;22(Suppl 1):STO003.

Association of Robotic Pleurectomy and Cytoreduction with Hyperthermic Intrathoracic Chemotherapy (HITHOC) for pleural recurrence of Type AB Thymoma

Juliana Vieira de Oliveira

Salerno

, Hyroan Brandell Pereira

Correa

, Paula Duarte

D'Ambrosio

, Fabio Eiti Nishibe

Minamoto

, Jaqueline Shaparini

Fonini

, Alberto Jorge Monteiro Dela

Vega

, Ricardo Mingarini

Terra

DOI: 10.31744/einstein_journal/2024ABS_BTS_STO003

Category: Robotic Technology in Thoracic Diseases

Introduction:

Although usually of an indolent nature, thymoma recurrence rates vary between 15% and 50%.⁽⁾ While surgery remains the cornerstone of treatment, advanced or recurrent thymomas present significant challenges due to their invasive nature and propensity for local recurrence. Hyperthermic intrathoracic chemotherapy (HITHOC) has emerged as a promising adjunctive therapy to address these challenges.^(,) This case report presents the utility and outcomes of HITHOC associated with robotic-assisted thoracic surgery (RATS) in the management of a recurrent thymoma.

Methods:

This retrospective case had demographic, perioperative, and postoperative data gathered, analyzed, and reported with descriptive statistics.

Results:

We present a case of a 41-year-old female, with a history of Type AB Thymoma, resected in 2021 measuring 9.4 cm. At the time, histopathological analysis revealed an intact capsule, without microscopic invasion, clear margins, and no angiolymphatic invasion. However, in 2024, during a routine follow-up, a new PET scan revealed an elongated nodular formation in the subaortic region (2.2×1.0cm), with an uptake of 4.5, suggesting recurrence. Additionally, another smaller nodular formation was identified, inferior to the described lesion, measuring 0.5cm, without significant uptake. In light of these findings, after multidisciplinary discussion, cytoreduction and adjuvant intrapleural hyperthermic chemotherapy were opted for. Utilizing the da Vinci XI robotic platform, complete parietal pleurectomy and resection of the lesions on the left visceral pleura, pericardium, and subaortic lymph node were performed. Subsequently, the tubes for infusion and drainage of the HITHOC were placed and after closing the thoracic cavity, hyperthermic chemotherapy with cisplatin and doxorubicin was conducted for 60 minutes, maintaining the temperature around 42°C with continuous monitoring. After completion, the pleural cavity was opened, hemostasis was revised, and two 28 Fr drains were placed. In the postoperative period, the patient was successfully extubated, remaining in the ICU for one day for intensive monitoring. Her recovery proceeded without complications, and after seven days the drains were removed. On the seventh day, the patient was discharged from the hospital. The patient continues to be regularly monitored, and so far has shown no signs of recurrence.

Conclusion:

This case report highlights the challenges faced in managing recurrent. Thymoma and underscores the efficacy of minimally invasive surgical approach with Robotic Surgery combined with HITHOC in an attempt to control the disease and improve patient survival.