Background/Objectives: This study aimed to assess the safety and efficacy of lung surgery for the treatment of early-stage non-small cell lung cancer (NSCLC) in octogenarians, with a specific focus on the Uniportal-VATS approach, evaluating surgical outcomes and short-term oncological results within a precision medicine perspective. Methods: This retrospective, single-center study included octogenarian patients who underwent surgical treatment for early-stage NSCLC between January 2018 and March 2024. Among 1329 patients treated during the study period, 136 octogenarians were carefully evaluated by a multidisciplinary board and selected for surgical management. Results: The mean age was 82.41 ± 2.72 years, with a prevalence of men (63.2%). In 107 (78.7%) cases, lung resection was performed using the Uniportal-video-assisted thoracic surgery (U-VATS) approach. Overall, 71 lobectomies (52.2%) and 65 segmentectomies or wedge resections (47.8%) were performed, balancing oncological radicality with comorbidities. Only minor complications occurred, such as atelectasis (2.9%), atrial fibrillation (4.4%), pneumonia (1.5%), or air-leakage (2.2%). Factors significantly associated with postoperative complications included open approach (p = 0.014), lobectomy as the extent of resection (p = 0.008), and chronic obstructive pulmonary disease (COPD) (p = 0.010). On multivariable analysis, lobectomy remained the only independent predictor for postoperative complications (OR: 5.95, 95% CI [1.24-28.62], p = 0.026). In-hospital and 90-day mortality were null. The median length of hospital stay in octogenarians was 6 days and was significantly shorter in the Uniportal-VATS group compared with the open surgery one (p < 0.001). All patients were discharged home independently. One- and three-year overall survival rates were 88% and 71%, respectively. No risk factor was associated with mortality in our series. Conclusions: Lung surgery, particularly the Uniportal-VATS approach, appears to be a safe and effective treatment option for octogenarian patients with early-stage NSCLC, provided that patient selection is carefully based on individual clinical characteristics within a multidisciplinary framework based on individualized risk stratification. When feasible, sublobar resection should be preferred in order to minimize postoperative complications.

The role of secondary cytoreductive surgery (SCS) in recurrent ovarian cancer has increased in recent years. Randomized prospective trials have shown a survival advantage in cases of complete gross resection.1,2 In this context, minimally invasive surgery has taken on a significant role, especially in cases of single and oligometastatic recurrence.3–6 The aim of this video is to describe the feasibility of a robotic triple-site approach for SCS in recurrent ovarian cancer. A case of oligometastatic platinum-sensitive ovarian cancer recurrence in a woman in her 40s is presented. Preoperative computed and emission tomography scans detected three sites of recurrence: a right cardiophrenic lymph node, a nodule at the hepatic hilum between the head of the pancreas and the hepatic artery, and interaortocaval lymphadenopathy below the left renal vein. After a preoperative 3D reconstruction, a robotic SCS was performed in three anatomical regions. Complete cytoreduction was achieved. The operation time was 200 min, and the estimated blood loss was 100 mL. The patient underwent extensive adhesiolysis because of previous surgery. No intraoperative complications occurred. The histological examination confirmed the metastatic involvement of the three lesions. A robotic approach can be considered in selected patients with extrapelvic ovarian cancer recurrence, even in different anatomical sites, in oncological centers with a multidisciplinary team of expert surgeons. Patient selection and preoperative 3D reconstruction are very important elements in the surgical planning.

Post-operative hemothorax (PH) is one of the most critical complications in thoracic surgery, which requires prompt treatment. The aim of the study is to review the consecutive series of patients with PH undergoing re-operation in Uniportal Video-Assisted Thoracic Surgery (U-VATS) or Thoracotomy, analyzing the outcomes and costs. Out of 1663 patients undergone Thoracic operations (pulmonary resections, esophagectomies, or pleural/chest wall lesions) between 2016 and 2024, 52 (3.12%) developed a PH and underwent surgical treatment. Data of patients were collected and retrospectively analyzed. Thirty-six patients were male (69.23%), with a mean age of 62.54 ± 16.46 years. Active bleeding was intraoperatively discovered in a total of 35 patients (67.30%). Most of the patients who developed PH had undergone a previous wedge resection (20, 38.46%) and in 15 cases (28.84%), the cause was pleural/parenchyma bleeding. Post-operative complications were significantly higher in the group of patients who underwent treatment of PH by thoracotomy (10 (34.48%) vs 2 (8.69%), P:0.028), and 14 patients (48.27%) required ICU admission(P:0.020). Patients with post-operative complications had a significantly longer hospital-stay (9.33 ± 5.02 vs 4.83 ± 2.09 days: <0.001). In general, post-operative hospital-stay was also longer in the thoracotomy group (7.07 ± 3.83 vs 4.35 ± 2.44 days, P:0.005). Total costs, including operating room expenses, hospital-stay, and ICU admission, were higher in the open group compared to U-VATS(6708.94 ± 2738.74 vs 5238.79 ± 2527.92€, P:0.052). Multivariable analysis identified the open approach as the only independent risk factor for complications (OR = 5.53, 95%CI [1.072-28.49], P:0.041). Open approach exposes to higher post-operative complications and costs, with longer hospital stay in case of reoperation for PH. U-VATS technique seems to be safe and effective and with lower costs, although the instruments are more expensive.

This study aims to evaluate residual apical space (RAS) as a predictor of pneumothorax recurrence in patients undergoing video-assisted thoracoscopic surgery (VATS) for primary spontaneous pneumothorax (PSP) and to assess its impact by surgical treatment type. Data of 463 patients undergoing VATS for PSP at three Italian high-volume thoracic surgery centers (January 2012-March 2023) were retrospectively reviewed. Exclusions included secondary pneumothorax, patients < 18 years, and those undergoing thoracotomy. Four surgical approaches were analyzed, with RAS measured using the Collins method (4.2

BACKGROUND/OBJECTIVES:Perioperative chemo-immunotherapy (CHT-IO) has emerged as a standard treatment strategy for resectable stage II-IIIB NSCLC. However, data regarding surgical feasibility, mini-invasive surgery rates, perioperative outcomes, and postoperative complications in real-world single-center experiences remain limited. METHODS:A retrospective single-center analysis was performed including consecutive patients with locally advanced NSCLC treated with perioperative chemo-immunotherapy between March 2024 and March 2026. Patients received platinum-based chemotherapy combined with pembrolizumab or durvalumab, followed by surgical resection with curative intent. Surgical, pathological, and postoperative outcomes were analyzed. RESULTS:Thirty patients received neoadjuvant CHT-IO, of which 25 (83.3%) underwent surgical resection. Reasons for failure to proceed to surgery included treatment-related toxicity or deterioration in performance status (n = 3), disease progression (n = 1), and patient refusal (n = 1). Lobectomy was the most performed procedure (64%), while a minimally invasive approach (uniportal VATS) was adopted in 44% of cases. Moderate-to-severe pleural adhesions (64%) and hilar fibrosis (60%) were observed intraoperatively. Despite these technical challenges, conversion to thoracotomy was required in only one case (4%), no intraoperative complications occurred, and complete (R0) resection was achieved in 96% of patients. Pathological complete response and major pathological response were observed in 36% and 52% of cases, respectively. Postoperative complications occurred in 56% of patients, although most were Clavien-Dindo grade I-II. The presence of comorbidities was the only factor associated with an increased risk of postoperative complications (OR 10.00, 95% CI 0.99-100.46; p = 0.05). Median length of hospital stay was 5.65 ± 2.04 days. One postoperative death due to septic complications was recorded. CONCLUSIONS:In this real-world monocentric experience, the combination of perioperative CH-ICIs and surgical resection (including mini-invasive approach) was safe and feasible in patients with locally advanced NSCLC. High rates of complete (R0) resection and encouraging pathological responses were observed, consistent with outcomes reported in randomized trials. Although surgery was overall frequently technically demanding, these changes did not appear to compromise perioperative safety or oncological radicality, even when minimally invasive approaches were adopted. Larger studies with longer follow-up are needed to better define long-term oncological outcomes.

Thymic epithelial tumors presented a variable 5-year survival rate, histological subtype dependent. Efforts have been made to identify new prognostic markers. Neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), and Systemic Inflammatory Index (SII) proved effective in predicting survival in other solid tumors. We evaluated the prognostic significance of NLR, PLR, and SII on disease-free, overall, and tumor-related survivals in patients undergoing surgery with radical intent for thymic epithelial neoplasms. We conducted a retrospective analysis in patients operated in four high-volume Italian thoracic surgery centers, followed for a minimum period of 6 months. Immediate preoperative values of NLR, PLR, and SII were recorded. Patients were categorized for each factor based on cutoff values determined statistically by using the Youden index. Survival outcomes were analyzed using Kaplan–Meier curves, log-rank tests, and multivariable Cox regression after propensity score matching (1:1) performed for each inflammatory index. A total of 376 patients were enrolled. The mean values for NLR, PLR, and SII were 3.0 (3.2), 131.4 (84.1), and 754.6 (28.8), respectively. The calculated cutoff values were 2.9 for NLR, 123.8 for PLR, and 489.0 for SII. After propensity score matching, we obtained 212 cases for NLR, 256 for PLR, and 280 for SII. Multivariable Cox regression analysis revealed a significant association between tumor-related survival and NLR (p = 0.030) and SII (p = 0.033). Higher NLR and SII cutoff values can be considered predictors of worse thymic epithelial tumors-related survival after surgery, suggesting their potential role in long-term risk stratification.

The number of long-term survivors after pancreatic cancer is increasing due to recent advances in diagnosis and multidisciplinary treatments. However, the effectiveness of pulmonary metastasectomy remains uninvestigated. This study aims to evaluate the oncological outcomes of pulmonary metastasectomy in pancreatic cancer and to identify potential prognostic factors affecting survival. Patients undergone pulmonary metastasectomy, with previous radical surgery on pancreatic cancer and no evidence of disease in other organs, were selected. Therefore, clinical data of 56 patients from 7 high-volume centers were retrospectively analyzed. Long-term oncological outcomes and prognostic factors were evaluated. Five- and 10-year OS from pancreatectomy were 76

Granular cell tumors (GCTs) are rare neoplasms, typically of Schwannian origin, with generally a benign and indolent clinical behavior. However, a small subset exhibits malignant behavior, often without clear histologic features. We report a rare case of a vulvar granular cell tumor in a 21-yr-old woman with subsequent pulmonary metastasis. The patient presented with a slowly growing vulvar nodule and a subcutaneous lesion on the left flank. Imaging studies revealed residual disease in the vulva and a suspicious lung nodule, both of which were surgically resected. Histopathologic examination confirmed features consistent with granular cell tumor in both primary and metastatic sites, despite the absence of cytologic atypia, necrosis, or elevated mitotic activity. Immunohistochemistry revealed positivity for S100, CD68, NSE, and inhibin, with a low Ki-67 index (<1%). Next-generation sequencing identified a CHEK2 p.I200T mutation in both lesions, suggesting a shared clonal origin. This variant lies within the kinase domain of CHK2, a key mediator of the DNA damage response, and is of uncertain but potentially pathogenic significance. No microsatellite instability or homologous recombination deficiency was observed. This case highlights the diagnostic challenges in GCTs, particularly in distinguishing benign from malignant forms in the absence of classic histologic criteria. The presence of metastasis remains the most definitive indicator of malignancy. Our findings underscore the importance of integrating molecular profiling into the diagnostic and prognostic workup of GCTs and raise the question about the potential role of CHEK2 alterations as additional molecular determinants of aggressiveness beyond conventional histology. Long-term follow-up is warranted given the unpredictable clinical behavior of malignant GCTs.

Robotic-assisted thoracic surgery (RATS) has undergone rapid technological evolution over the past two decades, progressively expanding from early minimally invasive applications to increasingly complex thoracic procedures. This narrative review examines the historical development of robotic platforms in thoracic surgery, the emergence of new approaches and alternative robotic systems, and future technological perspectives. A literature search was conducted using PubMed/MEDLINE, Embase, Scopus, Web of Science Core Collection, and the Cochrane Library to identify relevant English-language publications through May 2026. Early robotic systems established the feasibility of robotic thoracic procedures, particularly mediastinal surgery and selected pulmonary resections, while also defining the technical limitations that shaped early practice, including demanding docking, arm-collision issues, dependence on bedside assistance, and lack of console-controlled stapling. The da Vinci Xi refined multiport robotic surgery through improved arm design, overhead boom architecture, simplified docking, and integrated stapling, supporting greater standardization and broader adoption of robotic thoracic surgery. In parallel, reduced-port approaches, including biportal and uniportal RATS, emerged through technical adaptation of existing platforms. The da Vinci SP introduced a dedicated single-port architecture, whereas the da Vinci 5 represents a further step toward haptic feedback and data-driven robotic surgery. Emerging systems such as Versius, Hugo RAS, Toumai, and Shurui SP reflect a diversifying robotic landscape, with modular, portable, and lower-cost design, that may influence future access and adoption. Future developments include artificial intelligence, augmented reality, digital twins, autonomous assistance, and remote surgery. Overall, robotic thoracic surgery is evolving from a purely mechanical platform toward a more integrated digital surgical environment, although the clinical impact, accessibility, training requirements, and long-term benefits of many emerging technologies remain to be fully established.

BackgroundMultidisciplinary management is essential in thoracic oncology to optimize diagnostic assessment, treatment planning, and patient selection for surgery. Structured clinical pathways may improve coordination among specialists and reduce delays in the management of patients with suspected or confirmed lung cancer.MethodsWe retrospectively analyzed patients managed within a structured Lung Cancer Pathway (LCP) at Fondazione Policlinico Universitario A. Gemelli IRCCS between January 2018 and December 2024. All patients entering the LCP were included, regardless of final treatment allocation. The pathway involved multidisciplinary assessment including thoracic surgeons, pulmonologists, oncologists, radiologists, pathologists, nuclear medicine specialists, and interventional specialists. The primary endpoints were: -time from LCP initiation to clinical record closure;-time from clinical record closure to surgical intervention.Workflow times were analyzed using median values and interquartile ranges (IQR). Differences between 2018 and 2024 were assessed using the Mann–Whitney U test, while temporal trends across the study period were evaluated using the Kruskal–Wallis test.ResultsA total of 2,691 patients were included. During the study period, the annual number of patients increased progressively, reflecting the expansion of the pathway. The median duration of the LCP significantly decreased from 9 days (IQR 2–23) in 2018 to 1 day (IQR 0–8) in 2024 (p < 0.001). A significant temporal trend was observed across the entire study period (p < 0.001). The median time from LCP closure to surgery was 29 days (IQR 15–43) in 2018 and 35 days (IQR 23–43) in 2024 (p = 0.013). During multidisciplinary evaluation, 447 patients (16.6%) did not proceed to surgery because of advanced disease, comorbidities, functional limitations, or patient preference.ConclusionsA structured Lung Cancer Pathway was associated with improved efficiency of the diagnostic and decision-making process over a seven-year period. The LCP model allowed standardized evaluation of patients with suspected or confirmed lung cancer, including those ultimately considered unsuitable for surgery. Although the retrospective design does not allow causal inference, these findings support the potential value of structured multidisciplinary pathways in optimizing workflow organization and clinical decision-making in thoracic oncology.

Background: Contralateral recurrence following surgically treated primary spontaneous pneumothorax represents clinical concern yet remains poorly understood. This study aims to expand the current understanding by evaluating a large, multicenter cohort over a 10-year period and to determine the true incidence of contralateral recurrence assessing the potential role of clinical factors in risk stratification. Methods: A total of 479 patients surgically treated for PSP (2012-2024) across three Italian high-volume centers were retrospectively reviewed. Secondary pneumothorax, patients <18 years old, lung emphysema or intraparenchymal large bullae, and the thoracotomy approach were excluded. The association between categorical variables and contralateral recurrence was assessed using the chi-square (χ2) test, while the association with continuous variables was evaluated using the t-test. Time to recurrence was analyzed using Kaplan-Meier survival curves. Variables with a p-value < 0.05 were considered statistically significant. Results: We identified 59 patients who experienced contralateral recurrence: 45 were males, the mean age was 26.66 ± 12.32 and the mean BMI was 22.00 ± 2.92; only 13 were active smokers. Age (p < 0.001) and smoking history (p = 0.029) were significantly associated with contralateral recurrence in univariate analysis, though these were not confirmed in multivariate analysis. Among the cohort of recurrence, 53 patients only had a recurrence on the contralateral side, with a median time to recurrence of 139 days. The incidence rate ratio (IRR) of recurrence for patients with a mean age of <34 years was 1.23, which translates to a 23% increased risk. No significant impact of age (p = 0.25), sex (p = 0.67), or smoking (p = 0.59) on the time to recurrence on the other side was observed through Kaplan-Meier analysis. The peak incidence for the first episode of PNX surgically treated and contralateral recurrence was observed in October, November and January. Conclusions: This study highlights a 12% contralateral recurrence rate after PSP surgery. Younger age is associated with earlier contralateral recurrence. Seasonality may influence recurrence patterns. Further studies should explore underlying mechanisms and preventive strategies.

Background: Traumatic hemothorax is a common complication of blunt chest trauma and remains associated with significant morbidity and mortality. Although contrast-enhanced computed tomography (CT) is central to diagnosis, the optimal criteria for selecting patients who require invasive management versus conservative treatment remain unclear. This study aimed to evaluate the management strategies and clinical outcomes of traumatic hemothorax and to identify predictors of surgical intervention and postoperative complications. Methods: We conducted a retrospective, single-center cohort study including adult patients admitted to a Level II Emergency Department with hemothorax following blunt chest trauma between January 2019 and December 2024. Primary outcomes were the need for urgent chest drainage or surgery. Secondary outcomes included postoperative complications, length of hospital stay, and intensive care unit admission. Univariable and multivariable regression analyses were performed to identify factors associated with surgical intervention and complications. Results: Seventy-two patients were included (mean age 60.0 ± 20.5 years; 80.6% male). Rib fractures were the most common cause of hemothorax (61.1%). Chest tube placement was required in 70.8% of cases, and 31.9% underwent urgent surgical intervention. Active bleeding on contrast-enhanced CT was identified in 16.7% of patients and was the only independent predictor of urgent surgery (OR 3.85, 95% CI 1.07-13.88; p = 0.039). The initial volume of blood drained after chest tube insertion did not differ between surgically and non-surgically managed patients. Conservative management was successful in 19.4% of cases. Postoperative complications occurred in five patients and were associated with a higher comorbidity burden. Overall mortality was 5.6%. Conclusions: In traumatic hemothorax following blunt chest trauma, active bleeding on contrast-enhanced CT seems to be the strongest predictor of urgent surgical intervention, whereas initial pleural drainage volume alone is not. Conservative management is safe in selected patients, while comorbidities influence postoperative outcomes. Multidisciplinary management and accurate radiological assessment are essential to guide timely and appropriate treatment.

Background: Oesophageal perforation (OP) is a life-threatening condition requiring prompt diagnosis and treatment. Mortality is influenced by several factors, such as aetiology, defect location, comorbidities, age, and delays in treatment. This study reviews patients with OP undergoing surgery, analysing mortality risks and the impact of timing on surgical outcomes. Methods: Medical records of 45 patients surgically treated for OP across three tertiary centers were analysed. Results: Of the 45 patients, 31 were male (68.88%) and 14 were female (31.11%), with a mean age of 66.00 ± 17.75 years. Pre-operative CT was performed in all patients, and 18 (40%) underwent oesophagogastroduodenoscopy. As many as 25 patients (55.55%) presented within 24 h, 10 (22.22%) within 24-72 h, and 10 (22.22%) after 72 h. Symptoms included pain, vomiting, fever, dysphagia, and subcutaneous emphysema. Foreign body ingestion and Boerhaave's syndrome were the leading causes (33.33% each), followed by caustic ingestion (17.77%) and iatrogenic and traumatic cases. Treatments included primary repair, debridement, oesophagectomy, and oesophagogastrectomy. Primary repair was performed in 22 cases (48.88%), and muscle flaps reinforced 11 of these. Direct repair showed the highest success rate when performed within 24 h. Thirty patients (66.66%) experienced complications, including respiratory failure, oesophagopleural fistula, and sub-stenosis. The hospital stay average was 36.34 ± 35.03 days. Nine patients underwent same-session/two-stage gastroplasty or retrosternal coloplasty for reconstruction, with complications including stenosis and leaks. Six patients (13.33%) died within the first 24 h after surgery, primarily due to severe comorbidities (three (50%) were octogenarians). Conclusions: OP is a life-threatening condition with high mortality. Primary repair is the preferred treatment. Oesophagectomy and gastrectomy are reserved for extensive lesions. Muscle flaps can reinforce sutures in cervical and thoracic perforations. Mortality is mainly influenced by the severity of the patient's clinical picture and comorbidities, rather than by time and type of treatment.

Background: Giant bullous emphysema (GBE), a severe form of chronic obstructive pulmonary disease, is characterized by large bullae that can occupy significant portions of the thorax, leading to compromised lung function and serious complications like spontaneous pneumothorax. Nowadays, this type of disease is known to be addressed in a minimally invasive through video-assisted thoracoscopic surgery (VATS), with an increasing trend towards the uniportal video-assisted thoracoscopy (U-VATS) technique due to its positive outcomes. Case Description: We report the case of a 34-year-old non-smoking male with symptomatic GBE affecting the right upper lobe (RUL) discovered by high-resolution computed tomography (HRCT), who underwent surgical treatment by U-VATS technique. The stapler line of the resection was reinforced by buttressed materials to prevent air leakage due to the fragility of lung parenchyma, therefore chemical pleurodesis was deemed unnecessary. Surgery was effective with complete right lung inflation after bulla removal. The postoperative course was uneventful, with discharge on postoperative day 4. The patient demonstrated rapid clinical improvement, with low pain, fast recovery and improved pulmonary function. Conclusions: This case supports the effectiveness of U-VATS in managing GBE, minimizing surgical trauma and enhancing outcomes. The integration of advanced surgical techniques, such as the use of reinforced staplers, plays a crucial role in optimizing patient care. Further research is warranted to assess long-term efficacy and potential advancements in thoracic surgery for GBE management.

Background: The role of thymectomy in ocular myasthenia gravis (OMG) remains controversial, particularly before secondary generalization. Methods: We conducted a multicenter retrospective study on 174 OMG patients who underwent thymectomy (112 OMG, 62 generalized OMG [g-OMG]). The primary endpoint was complete stable remission (CSR; MGFA-PIS criteria). Multivariable analyses identified predictors of CSR and generalization. Results: Mean age at surgery was 42.3 ± 13.0 years; 53.4% were male. Thymoma was present in 29.3%. CSR was achieved in 18.9% overall, significantly higher in OMG (23.2%) compared to g-OMG (11.3%, p = 0.036), with 5-year CSR probabilities of 43% vs. 22% (p = 0.017). In non-thymomatous patients, 5-year CSR remained higher in OMG (41% vs. 17%, p = 0.010). Postoperative myasthenic crisis occurred exclusively in g-OMG (8.1%, p = 0.004). Multivariable analysis identified preoperative cholinesterase inhibitor monotherapy as an independent predictor of CSR (HR = 31.776, 95% CI: 4.188–241.111, p = 0.001; non-thymomatous: HR = 19.746, 95% CI: 2.518–154.849, p = 0.005). Minimally invasive techniques (78.6%) were associated with low morbidity (5.2%). Conclusions: Thymectomy during the purely ocular stage is associated with higher CSR rates and lower perioperative neurological risk than after generalization, particularly in non-thymomatous disease. Use of cholinesterase inhibitors as sole therapy prior to thymectomy independently predicts CSR. These findings support earlier surgical consideration in selected OMG patients and highlight the safety of minimally invasive approaches.

For over two decades, robotic-assisted thoracic surgery (RATS) has revolutionized thoracic oncology. With enhanced visualization, dexterity, and precision, RATS has reduced blood loss, shortened hospital stays, and sped up recovery compared to traditional surgery or video-assisted thoracoscopic surgery (VATS). The use of 3D high-definition imaging and articulated instruments allows for complex resections and advanced lymph node assessment. RATS delivers oncological outcomes similar to open surgery and VATS, with high rates of complete (R0) resections and acceptable complication rates. Its minimally invasive nature promotes quicker recovery. Advances in imaging software and augmented reality further enhance surgical accuracy and reduce intraoperative risks. However, RATS has some limitations, including high costs and a lack of tactile feedback, and certain complex procedures, such as extended resections and intrapericardial interventions, remain challenging. With growing experience and technological advances, RATS shows promise in reducing morbidity, improving quality of life, and expanding access to advanced oncologic care. This article reviews the evolution, benefits, and limitations of RATS in NSCLC treatment, highlighting its emerging role in managing complex cases.

Introduction:Thymoma-associated myasthenia gravis (TAMG) accounts for 15-20% of all myasthenia gravis (MG) cases and is typically characterized by severe clinical manifestations and suboptimal response to conventional therapies. However, TAMG patients are underrepresented in clinical trials, leaving gaps in evidence for optimal treatment strategies. This study assessed the efficacy of complement inhibitors (CI) in TAMG population. Methods:We retrospectively reviewed 23 TAMG patients who received CI, with a minimum follow-up of six months. Additionally, we randomly included 22 MG patients without thymoma, treated with CI, in the control group. Clinical outcomes were measured using Myasthenia Gravis-Activities of Daily Living (MG-ADL) and Quantitative Myasthenia Gravis (QMG) scores at baseline, three, and six months. Results:Among the 23 TAMG patients, 21 initiated CI after thymectomy, with a median interval of eight years (IQR:2.5-15) post-surgery. Two patients achieved sufficient stabilization on CI to undergo thymectomy thereafter. The most frequent thymoma histological subtype was WHO type B2, detected in 43.5% of cases. Median MG-ADL score decreased from 11 (IQR:8-15) to 3 (IQR:2-5) and 4 (IQR:1-5) at three and six months, respectively (both p<0.001). Median QMG score decreased from 16 (IQR:14-22) to 10 (IQR: 5-11) at three and six months (both p<0.001). Prednisone dosage was tapered in 20 patients. No significant differences were observed between TAMG and MG patients without thymoma in MG-ADL, QMG and steroid reduction. Conclusion:CI demonstrated significant improvements in MG-ADL and QMG scores, along with a steroid-sparing effect, suggesting its potential as an effective treatment for this challenging subpopulation.