Thymic epithelial tumours (TETs), namely thymomas and thymic carcinomas (TCs), are rare neoplasms of thymic epithelial origin. TETs present in different clinical stages and show a variety of histological patterns. They are being treated in small numbers in many different centres worldwide with heterogeneous diagnostic and therapeutic algorithms. Advanced-stage TETs with pleural or pericardial dissemination (Masaoka-Koga Stage IVA [1]) are encountered in only 6.8% of all patients with TETs [1–3]. The best treatment for Stage IVA TETs still has to be defined. Complete surgical resection is the mainstay of treatment for patients with TETs. For patients with metastases of TETs to the visceral or parietal pleura, different surgical techniques are employed. Surgical techniques vary from extrapleural pneumonectomy (EPP) to total pleurectomy (TP) or local pleurectomy (LP), and frequently resections are combined with chemotherapy (ChT) and/or radiotherapy (RT) [4, 5]. In general, the indication to perform EPP is the finding of numerous visceral and parietal pleural and pericardial implants (and pulmonary nodules) that cannot be locally resected [6]. TP is the removal of all parietal, mediastinal and diaphragmatic pleural surfaces and pericardium with or without resection of the diaphragm. The decision to perform TP is made when visceral pleura and lung are not affected by malignant disease. LP is metastasectomy (local resection) of pleural implants without removal of all pleural surfaces. It is performed for mono- or oligometastatic disease.