Resection of giant right-sided thymoma using a lateral thoracotomy approach followed by median sternotomy for completion thymectomy

A 48-year-old woman was diagnosed with a giant, 20 x 18 x 9 cm, right-sided thymoma. A right posterolateral thoracotomy was performed to resect this lesion. The pathological diagnosis revealed a stage I thymoma according to Masaoka et al. [1]. Although, in general, a sternotomy approach is preferred for thymectomies, because of its sheer size, this tumor was approached through a right thoracotomy. Recurrent thymomas originating from remnants of the thymus gland have been described in several individual case reports. Apart from these experiences, recent studies indicate a significant increase in the risk of recurrence for thymomas larger than 8 cm. In our patient, the remaining thymus gland portions were removed through a midline sternotomy. There is no information in the literature how often a thoracotomy has had to be chosen over a preferred sternotomy as the initial surgical procedure in order to resect a giant thymoma.