Surgical treatment of invasive thymomas: which approach?

Surgery is the mainstay of treatment of thymic epithelial neoplasms (1). Complete removal of the tumor and involved lymph-nodes is the aim of surgical treatment. Manipulation of the tumor should be limited in order to prevent cell seeding, which may lead to loco-regional recurrence of the disease (2). The choice of the surgical approach has a major role in determining the success of treatment. The ideal approach should provide an adequate exposure of the surgical field in order to achieve complete tumor removal and avoid intraoperative complications.