Surgical approaches for thymectomy: a narrative review

Background and Objective: Thymectomy continues to be a standard treatment strategy for patients with thymic neoplasms and myasthenia gravis. The total thymectomies performed has exponentially increased by 69.8% between 2012 and 2019. Trans-sternal and minimally invasive thymectomy increased by 62.8% and 83.7%, respectively. Our objective is to provide a narrative overview of the various approaches of thymectomy. We have briefly described the indications for thymectomy, discussed important preoperative considerations and an operative description of the different techniques of the procedure. We have aimed to summarize the pros and cons of each approach and narrated the technique we have adopted at the University of Minnesota. Methods: A literature search was conducted encompassing original full-length articles, meta-analyses, review articles and case reports up to July 2024 from the MEDLINE and Google Scholar databases. Key Content and Findings: Complete surgical resection remains the goal to decrease the risk of recurrence for non-myasthenic thymomas and thymic carcinomas. Surgical procedures have evolved from traditional open approaches to a wide variety of minimally invasive methods. A variety of factors specific to the tumor, patient and surgeon have to be considered while planning a thymectomy. Conclusions: As of today, there is no consensus on the best surgical technique, with each approach providing specific pros and cons. Each technique may be a viable option in the management of thymic pathologies, thus preoperative evaluation in patients is necessary to optimize prognosis and outcomes.