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OBJECTIVE: Thymic epithelial neoplasms presenting with intrapleural disease can effectively be treated with maximum cytoreductive therapy after initial induction chemotherapy. Achieving an R-0 resection is challenging due to micrometastatic disease. Hyperthermic perfused intrapleural chemotherapy (ITH) has been described as a method to treat minimal residual disease with effective cytotoxicity while avoiding systemic toxicity. We report the feasibility of employing a da Vinci Robotic Assisted approach for the resection of intrapleural disease and combined ITH as part of a multi-modality treatment for advanced thymic malignancy.
METHODS: A 47 year old woman presenting with ocular myasthenia gravis was diagnosed with a Masoaka Stage IVa, WHO Type B3 thymic malignancy with mediastinal invasion, extensive intrapleural disease including bulky interfissural pleural masses on presentation. She responded to systemic chemotherapy induction which facilitated transsternal resection of mediastinal tumor,partial pericardiectomy and en bloc wedgeresection of medial right lung. One month following this procedure a da Vinci Robotic assisted right sided cytoreductive operation resected all residual gross tumor . A one hour ITH perfusion with cisplatinum and adriamycin at 42-43 degrees C was completed.
RESULTS: Technical aspects and results of the cytoreductive procedure and perfusion technique will be demonstrated in the video.
CONCLUSIONS: A minimally invasive approach as part of aggressive maximally invasive cytoreduction surgery is technically feasible and may allow earlier completion of staged multi modality therapy for selected intrathoracic metastatic disorders. The distal articulated instrumentation of the da Vinci Robot facilitated the resection of tumors in a technically challenging workspace. Hyperthermic perfusion was facilitated by having a portal approach which limited the potential for leakage of perfusate.