Pleural Metastasectomy for Regionally Disseminated Recurrence of Thymoma

Thymoma, typically characterized by its indolent nature, carries the potential for metastatic dissemination in the pleural cavity. Disease recurrence is closely linked to thymic capsule invasion, with higher stages correlating with increased recurrence rates. Surgical resection, aiming for macroscopic complete resection (MCR), remains the preferred approach for disseminated disease. Fewer pleural nodules and MCR attainment confer improved overall survival (OS); however, surgeons should be aware that radiographic imaging often underestimates the extent of pleural disease. Given the recurrent nature of the disease, hyperthermic intrathoracic chemotherapy and more traditional systemic therapy show promise in prolonging disease-free intervals, albeit with uncertain OS benefits. These options underscore the necessity of individualized treatment strategies informed by disease burden and patient status in thymoma management. Patients with thymoma pleural recurrence should undergo surgical resection when a macroscopic complete resection is achievable.