After the first cardiothoracic surgeon said I had a thymoma and that he may need to do more than one surgery to remove everything, I got an appointment for a second opinion at Mayo Clinic - Phoenix seeing a thoracic surgeon. We discussed the overarching reason for the visit, which was the presumed paraneoplastic retinopathy, two pleural nodules that have increased in size, and a possible thymoma which was active on PET scan. While my outside imaging was loading into the system, he discussed the possibilities. He stated for paraneoplastic syndromes, he almost always recommends the removal of the thymus regardless of thymoma or activity on PET since this often contributes to the issue. Furthermore, he discussed the potential removal of the pleural nodules and what the surgery may entail and based off of the description, that he would likely need to resection the diaphragm.
During this discussion, the images finally loaded and he viewed the oldest CT first and stated their was not a lot of excess tissue at the thymus; however, he then viewed the PET and said there was something going on there and it needed to be removed. He observed that the pleural nodules did not have activity on the PET scan but proceeded to discuss that in paraneoplastic syndromes, this is not unusual. Then reviewing the most recent CT scan from July, he saw the increase in size and immediately stated the nodules needed to be removed.
From there we discussed the actual surgeries which would be a thymectomy (removal of the thymus), wedge resection of the pleural and lung, and resection and reconstruction of the diaphragm. This would be done via VATS (video assisted thorascopic surgery) with three main insertions of the tools and camera with the possibility of two additional insertions depending on how well they can visualize the nerves and vessels. Since my imaging is already four months old, I will be doing a repeat CT scan prior to surgery so they can better visualize the issues prior to surgery. Furthermore, I will have an EKG to monitor my heart, baseline labs, and another appointment with the surgeon to review.
Recovery is expected to be about two weeks to light activity and eight weeks to full activity. Additionally, I won't be able to fly for awhile due to the risk of a collapsed lung (pneumothorax).