Reoperation on the thymus. A critique.

Reoperation on the thymus, including even multiple re-resection, is a useful modality in carefully selected patients for recurrent thymoma or for incompletely removed thymus. In the case of MG, reoperation is used for completion of an otherwise incomplete thymectomy, usually by the transcervical method, although it also has been used after primary sternotomy. Interestingly enough, no instances of reoperation after primary VATS thymectomy have been reported yet. Indeed, VATS has been used successfully for reoperation after previous transcervical and trans-sternal thymectomies. In the case of thymoma, there have been an increasing number of reports of reoperation, including multiple procedures, in many cases. It is important to interpret the results of reoperation in the context of the biologic behavior of the thymus tumor. Thus far, no formal guidelines have been established for the follow-up of these patients. It is believed that all cases of thymectomy with or without thymoma and with or without MG should be followed for the lifetime of the patient with periodic examinations and imaging.