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If you delete the third party updates you arent using in patch manager it will delete the content saved in that folder. If you delete the content there, the packages will fail to install when called upon. I would not delete anything in that folder manually.
Back when I first took over patch manager a few years ago that folder was 90 GB. I set out to clear out old and expired updates and got it down to 40 GB which is about where it is now and is normal.