Stage IVA thymoma: patterns of spread and surgical management.

Stage IVA disease can be de novo disease or more commonly represent recurrent disease. The pleura is the most common site of relapse after thymoma resection. Local pleural disease is usually simply resected. This is usually combined with either induction or adjuvant chemotherapy. The ultimate extended surgery for advanced thymic tumors is an extrapleural pneumonectomy done for extensive pleural disease. This rarely performed operation is done for both stage IVA disease found at initial presentation and for recurrent disease as a salvage procedure. Again, these advanced patients with pleural spread are probably best managed by induction chemotherapy followed by resection.