Salvage resection via a trans-manubrial approach after definitive chemoradiotherapy for initially unresectable thymic carcinoma in the superior mediastinum: a case report.

BACKGROUND

Initially unresectable thymic carcinoma poses significant management challenges, and the role of salvage resection after definitive chemoradiotherapy has limited evidence.

CASE DESCRIPTION: We report a successful case of complete salvage resection via a trans-manubrial approach. A 48-year-old man presented with hoarseness and was diagnosed with thymic squamous cell carcinoma originating from the superior mediastinum, invading the aortic arch and arch vessels, and metastasizing to a left supraclavicular lymph node (LN; T4N2M0). He underwent definitive chemoradiotherapy with two cycles of carboplatin and nab-paclitaxel with 60 Gy, resulting in a partial response (PR) on computed tomography. For presumed residual disease, salvage surgery was performed. A left-sided trans-manubrial approach was selected to allow safe exposure of the superior mediastinum and potential control of the aortic arch vessels. Intraoperative findings showed no macroscopic invasion of the aortic arch, trachea, or esophagus. The postoperative course was uneventful. Histopathological examination of the entire tumor bed revealed no residual viable tumor cells, indicating a pathological complete response.

CONCLUSIONS

Salvage resection after chemoradiotherapy for initially unresectable thymic carcinoma may be feasible and potentially curative in carefully selected patients. This case highlights both the usefulness of a trans-manubrial approach for superior mediastinal lesions and the challenges in accurately assessing a residual disease after chemoradiotherapy.