Table 1.

Surgical approach for giant thymoma

Approach	n	Cases	Remarks
Median sternotomy [reference 4–6]	3	Anterior masses	Suitable for invasion into innominate vein
			Possible blind spot caused by anterior mass
Hemiclamshell [reference 12–14]	3	Large masses occupying more than half of thorax	Easy access to the mediastinum and hilum
			Relatively invasive
Posterolateral [reference 8, 9]	2	Masses close to the diaphragm	Suitable for inferior mediastinal masses
			Requires thymectomy at second operation
			Unsuitable for antero-superior mediastinal masses
Anterolateral [reference 2, 3]	2	Antero-inferior masses	Possible to extend the incision posteriorly or with median sternotomy
		Ectopic mass	Unsuitable in cases that are unstable in the decubitus position
Clamshell [reference 7]	1	Masses with bleeding	Quick access to the hilum and tumor control
			Invasive