Cytoreductive Surgery with Radical Pleurectomy/Decortication and Intraoperative photodynamic therapy as a treatment for Stage IVa and pleural recurrence thymic tumors.

Background: Managing stage IV thymoma with pleural spread or recurrence remains a complex clinical challenge. While complete resection is considered essential for achieving long-term survival, its feasibility and outcomes vary. Inspired by surgical strategies used in malignant pleural mesothelioma, we applied a multimodal approach combining extensive thymectomy, cytoreductive lung-preserving pleurectomy/decortication, and intraoperative photodynamic therapy (PDT) to enhance local control and survival outcomes.