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Thymic epithelial tumors (TETs) are rare neoplasms. While treatment guidelines for early stage TETs are well established, treatment for advanced and locally invasive and metastatic TETs (Masaoka stage IVa/IVb) is varied. Many studies examining outcomes in this patient population are single institution, retrospective studies with small sample sizes. Further complicating study of advanced TETs is that Masaoka stage IVa/IVb describes a wide variety of disease heterogeneity, and includes both thymoma and thymic carcinoma. Thus, recommendations for treatment strategies vary widely. Surgical resection with an R0 resection is a key component of treatment for early stage TETs, however the utility of surgery and appropriate surgical approach for patients with locally invasive disease is debated and ranges from local metastasectomy to extrapleural pneumonectomy (EPP). The use of multimodal therapies, including adjuvant and neoadjuvant radiation and chemoradiation, are important for patients with locally advanced disease, however identifying patients who would most benefit from each strategy has been challenging. In this review we examined the literature to provide treatment strategies for advanced TETs. Surgery with an R0 resection should be attempted in all risk appropriate patients. Multimodal therapies are likely beneficial to patients particularly with locally advanced disease, and neoadjuvant therapies may increase likelihood of R0 resection. Further investigation is necessary to identify optimal treatment strategies for patients with locally advanced TETs., Competing Interests: Conflicts of Interest: All authors have completed the ICMJE uniform disclosure form (available at http://dx.doi.org/10.21037/med-20-34). The series “Dedicated to the 10th International Thymic Malignancy Interest Group Annual Meeting (ITMIG 2019)” was commissioned by the editorial office without any funding or sponsorship. The authors have no other conflicts of interest to declare., (2021 Mediastinum. All rights reserved.)

As a result of the rapid acceleration in new treatment advances in thoracic oncology, coordination and tailored selection of treatment modalities has become complex. This increasing complexity mandates multidisciplinary input and coordinated management. However, quality of care in the domain of multidisciplinary thoracic oncology has yet to be purposefully defined, and as a result the science of performance measurement has yet to be applied to this area. In this review we discuss the role of multi-disciplinary care in thoracic oncology, and outline its definitions as proposed in the literature. We review various metrics of quality in complex multidisciplinary thoracic oncology care, and future directions for quality and performance measurement., Competing Interests: Conflicts of Interest: The authors have no conflicts of interest to declare.

Despite progress in many different domains of surgical care, we are still striving toward practices which will consistently lead to the best care for an increasingly complex surgical population. Thoracic surgical patients, as a group, have multiple medical co-morbidities and are at increased risk for developing complications after surgical intervention. Our healthcare systems have been focused on treating complications as they occur in the hopes of minimizing their impact, as well as aiding in recovery. In recent years there has emerged a body of evidence outlining opportunities to optimize patients and likely prevent or decrease the impact of many complications. The purpose of this review article is to summarize four major domains-optimal pain control, nutritional status, functional fitness, and smoking cessation-all of which can have a substantial impact on the thoracic surgical patient's course in the hospital-as well as to describe opportunities for improvement, and areas for future research efforts., Competing Interests: Conflicts of Interest: TK Varghese Jr: National Cancer Institute RO1 funding (1R01CA211705-01A1) for Precision Exercise Prescription (PEP) Clinical Trial for patients undergoing Lung Cancer Resection; Medical Director, American College of Surgeons Strong for Surgery program (https://www.facs.org/quality-programs/strong-for-surgery). The other authors have no conflicts of interest to declare.

Competing Interests: Conflicts of Interest: The author has no conflicts of interest to declare.