Piergiorgio Muriana ^*

• San Raffaele Scientific Institute (IRCCS), Milan, Italy

Text 8The interaction between thymic epithelial tumors (TETs) and myasthenia gravis (MG) represents a 9 fascinating and complex field in oncology, neuroscience, and thoracic surgery. Advances in minimally 10 invasive surgery (MIS) and an evolving understanding of MG's pathophysiology have significantly 11 improved patient care. TETs, the most common anterior mediastinal tumors, highlight the importance 12 of surgery in achieving curative outcomes, especially in early-stage disease. Likewise, MG is 13 commonly managed through thymectomy to alleviate symptoms and influence disease progression. 14 Despite these advances, critical questions remain, necessitating further exploration of evolving 15 strategies and challenges. 16 Surgical resection is the cornerstone treatment for TETs, providing excellent long-term 17 outcomes despite challenges like large tumor size and mediastinal invasion even at the presentation of 18 the disease. A meta-analysis demonstrated pooled 5-year and 10-year overall survival rates of 84% and 19 73%, respectively, across over 11,000 patients (1). Among all the prognostic factors, complete 20 resection (R0) significantly improves prognosis, even in advanced stages, highlighting its importance. 21The multicenter randomized Thymectomy The authors emphasize the critical role of the surgeon's expertise in achieving favorable outcomes. 57 While these approaches are optimal for early-stage cases, the exclusion of advanced-stage tumors 58 highlights the need for tailored strategies based on individual tumor characteristics, disease stage, and 59 even the surgical center expertise. 60Leng et al compared subxiphoid (SA) and lateral intercostal (LA) VATS approaches in 61 resecting anterior mediastinal masses. The SA approach was later introduced in the clinical practice as 62 an alternative to LA approach for the treatment of large masses providing superior exposure. Their 63 retrospective analysis of 91 patients shows that, in two homogeneous groups, the LA approach offered 64 shorter operative times, reduced hospital stays, and lower costs, making it an efficient choice for early-65 stage tumors. Both approaches had comparable safety profiles and low complication rates, though the 66 steep learning curve of SA might explain its longer operative times and higher costs. The authors 67 conclude that the choice of approach should consider tumor characteristics and patient-specific factors. 68Meng et al present a case report of multimodal treatment in a patient with unresectable thymic 69 carcinoma, highlighting the role of immunotherapy in managing refractory disease. Their use of 70 sintilimab, a PD-1 inhibitor, achieved prolonged partial remission after unresponsiveness to traditional 71 treatments, underscoring the potential of immunotherapy for advanced or unresectable disease. This 72 aligns with the broader shift towards personalized treatment strategies and innovative systemic 73 therapies, particularly for advanced cases. 74These studies collectively emphasize a nuanced approach to managing TETs and MG. MIS 75 continue to demonstrate significant benefits for early-stage disease, while systemic therapies, such as 76 immunotherapy, are increasingly critical for advanced or recurrent cases. The integration of surgical 77 expertise with novel systemic approaches underscores the importance of interdisciplinary 78 89This manuscript was prepared with the assistance of a generative AI tool (ChatGPT, OpenAI) for 90 language refinement and improving manuscript clarity. The author has thoroughly reviewed and 91 verified all AI-assisted content to ensure its accuracy and originality. The use of this tool complies with 92 ethical guidelines and does not affect the author's responsibility for the integrity and validity of the 93 research presented. 94 6