(1) Background. Intracavitary hyperthermic chemotherapy (HITHOC) remains a part of the complex mosaic which is the multimodal approach in advanced stage thymomas and pleural malignancies, and its role is still widely debated. In recent years, several studies have demonstrated the feasibility and the efficacy of HITHOC combined with cytoreductive surgery in the treatment of thymoma relapses and malignant pleural mesothelioma (MPM). However, there are currently no studies available on pleurectomy/removal of pleural lesions using the robotic technique, in association with intrathoracic chemotherapy. The aim of this narrative review is to evaluate the feasibility and safety of robotic pleurectomy/removal of relapses and HITHOC in patients with pleural recurrence of thymoma or MPM, after having analyzed the literature concerning this controversial topic, and to report our experience with robotic surgery. (2) Methods: A review of papers published on this topic, from 1980, was conducted. Later, the data of consecutive patients affected by thymoma relapses or MPM who underwent robotic surgery in combination with HITHOC will be collected and analyzed. The surgery performed, prior to intrathoracic infusion of the high-temperature chemotherapy, consisted of the removal of the recurrences or pleurectomy, depending on the pathology. All surgeries were performed with a 4-port-fully robotic technique. (3) Results: Between 2017 and 2022, nine patients underwent robotic cytoreductive surgery in combination with HITHOC. No intraoperative complications occurred. One patient had a grade II Clavien-Dindo postoperative complication. Oncological follow-up showed results in line with the literature. (4) Conclusion: With the limitation of the small number of patients, considering the results, robotic surgery may represent the surgical approach of choice, in combination with HITHOC, in patients with pleural relapses of thymoma and early-stage MPM.

Lung cancer remains the leading cause of cancer-related death worldwide. The involvement of lymph nodes by the tumor has a strong impact on survival of patients. For this reason, lymphadenectomy plays a crucial role in the staging and prognosis of NSCLC, to define the most appropriate therapeutic strategies concerning the stage of the disease. To date, the benefit, in terms of survival, of the different extents of lymphadenectomy remains controversial in the scientific community. It is recognized that metastatic involvement of mediastinal lymph nodes in lung cancer is one of the most significant prognostic factors, in terms of survival, and it is therefore mandatory to identify patients with lymph node metastases who may benefit from adjuvant therapies, to prevent distant disease and local recurrences. The purpose of this review is to evaluate, the role of lymphadenectomy in early-stage NSCLC in terms of efficacy and accuracy, comparing systematic, sampling and lobe-specific lymph node dissection and analyzing the existing critical issue, through a search of the most relevant articles published in the last decades.