Perioperative Challenges and Anaesthetic Management in Video-assisted Radical Thymectomy with Pleurectomy and Hyperthermic Intrathoracic Chemotherapy - A Case Report

Thymoma is a rare anterior mediastinal tumour that arises from thymic epithelial cells. It accounts for <1% of adult malignancies, with an incidence of 1.5 cases per million annually. It commonly affects individuals aged 40–60 years and may be associated with paraneoplastic syndromes. Thymomas are often slow-growing but can exhibit local invasion or pleural dissemination. Diagnosis involves advanced radiological imaging, with biopsy reserved for ambiguous cases. Management includes surgical resection, usually supplemented by chemotherapy, radiotherapy or hyperthermic intrathoracic chemotherapy (HITHOC) in pleural spread. HITHOC, involving heated perfusion of chemotherapeutic agents, enhances locoregional control by targeting microscopic disease. Perioperative challenges include lung isolation, prolonged surgery, temperature regulation and complex fluid balance, requiring close anaesthetic–surgical coordination. These considerations are exemplified in the presented case involving video-assisted thoracoscopic surgery, including radical thymectomy, pleurectomy and HITHOC in a patient with advanced thymoma and pleural metastasis.