Lapis ISSN 2398-2969

Thorax: thoracotomy

Contributor(s): David Perpinan, William Lewis

Introduction

  • Neoplasia of the thymus Thymus: neoplasia (mainly thymomas) is occasionally encountered in rabbits, mainly older ones . One study reported that thymus neoplasia represents 7% of all tumors in rabbits.
  • The prognosis for cases with thymoma is poor if left untreated.
  • Cure may be possible if the mass is completely removed via surgery, surgery and radiotherapy, or just radiotherapy (with the addition of prednisolone at 0.5 mg/kg BID).
  • Surgery involves thoracotomy and removal of the mass.

Uses

  • Surgical treatment of thymus neoplasia Thymus: neoplasia. It can be used as a single treatment or combined with radiation therapy.
  • Thoracotomy through a median sternotomy can also be used for procedures involving lungs or lower trachea, but these are seldom performed in rabbits. 
  • The most common indication for a lateral thoracotomy would be the removal of a lung lobe abscess. Other possible indications would include lung tumors, tracheal tumors, ruptured intrathoracic trachea, other thoracic tumors, thoracic foreign bodies, thoracic abscesses and potentially surgery relating to the pericardium, as well as congenital cardiac defects.

Advantages

  • It provides a good chance of removing the entire tumor and effecting a cure.
  • It provides the option to obtain a good-quality excisional biopsy.
  • It does not require the use of a radiation therapy unit, which is expensive and requires specialized personnel.
  • Surgical treatment with thoracotomy may be less expensive for the owner than radiation therapy.
  • Previous surgical treatment may facilitate success of radiation therapy (although it should be considered that surgical treatment may increase perioperative mortality by itself).
  • Radiation may also be used to shrink the size of the tumor prior to surgery.

Disadvantages

  • Technically challenging, but within the capabilities of an experienced first opinion small animal surgeon.
  • Carries high risk of complications, such as elevated perioperative mortality.
  • Radiation therapy is now the treatment of choice for thymus neoplasia.

Requirements

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Preparation

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Procedure

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Aftercare

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Outcomes

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Prognosis

  • Fairly good for the short term if the rabbit survives the anesthetic and initial surgical procedure. It is not unusual for survival times of more than one year to be reported.

Further Reading

Publications

Refereed Papers

  • Recent references from PubMed and VetMedResource.
  • Kuenzel F, Hittmair K M, Hassan J et al (2012) Thymomas in rabbits: clinical evaluation, diagnosis, and treatment. J Am Anim Hosp Assoc 48 (2), 97-104 PubMed.
  • Morrisey J & McEntee M (2005) Therapeutic options for thymoma in the rabbit. Semin Avian Exotic Pet Med 14 (3), 175-181 VetMedResource.
  • Clippinger T L & Bennett R A et al (1998) Removal of a thymoma via median sternotomy in a rabbit with recurrent appendicular neurofibrosarcoma. JAVMA 213 (98), 1140-1143 PubMed.

Other sources of information

  • Multimedia Manual of Cardio-Thoracic Surgery: Median Sternotomy. https://mmcts.org/tutorial/80.
  • Lewis W (2013) Mediastinal Masses and Other Thoracic Surgery. In: BSAVA Manual of Rabbit Surgery, Dentistry and Imaging. Eds: Harcourt-Brown F, Chitty J. pp 257-268.


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