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European Journal of Cardio-thoracic... May 2023Total thymectomy in addition to medical treatment is an accepted standard therapy for myasthenia gravis (MG). Patients with severe generalized MG present...
OBJECTIVES
Total thymectomy in addition to medical treatment is an accepted standard therapy for myasthenia gravis (MG). Patients with severe generalized MG present life-threatening events, poor prognosis and higher risk of postoperative myasthenic crisis. The aim of our study is to investigate neurological and surgical results in patients with Myasthenia Gravis Foundation of America (MGFA) class IV and V MG following thymectomy.
METHODS
Data on 76 MG patients with preoperative MGFA classes IV and V who underwent thymectomy were retrospectively collected. Primary end points included short-term surgical outcomes and long-term neurological results including the achievement of complete stable remission and any improvement as defined by MGFA Post-Intervention Status criteria.
RESULTS
There were 27 (35.5%) males and 49 (64.5%) females; 53 (69.7%) were classified as MGFA class IV and 23 (30.3%) as class V. Thymectomy was performed through sternotomy in 25 (32.9%) patients, Video-assisted thoracic surgery (VATS) in 5 (6.6%) and Robot-assisted thoracic surgery (RATS) in 46 (60.5%). The median operative time was 120 (interquartile range: 95; 148) min. In-hospital mortality was observed in 1 (1.3%) patient and postoperative complications in 14 (18.4%) patients. The median postoperative hospital stay was 4 (interquartile range: 3; 6) days. Pathological examination revealed 31 (40.8%) thymic hyperplasia/other benign and 45 (59.2%) thymomas. Cumulative complete stable remission and improvement probabilities were 20.6% and 83.7% at 5 years and 66.9% and 97.6% at 10 years, respectively. A significant improvement rate was found in patients with age at the time of thymectomy of ≤50 years (P = 0.0236), MGFA class V (P = 0.0154) and acetylcholine receptor antibodies positivity (P = 0.0152).
CONCLUSIONS
Thymectomy in patients with severe MG yields good perioperative outcomes and satisfactory long-term neurological improvement, especially for patients younger than 50 years, with MGFA class V and anti-AChR+ MG.
Topics: Male; Female; Humans; Thymectomy; Retrospective Studies; Myasthenia Gravis; Thymoma; Treatment Outcome; Thymus Neoplasms
PubMed: 37162377
DOI: 10.1093/ejcts/ezad179 -
Lupus 1997
Topics: Antiphospholipid Syndrome; Humans; Thymectomy
PubMed: 9289313
DOI: 10.1177/096120339700600501 -
The Journal of Thoracic and... Jul 2017Thymectomy is part of the therapeutic armamentarium for myasthenia gravis (MG). During the past 80 years, multiple observational studies have shown that thymectomy can...
Thymectomy is part of the therapeutic armamentarium for myasthenia gravis (MG). During the past 80 years, multiple observational studies have shown that thymectomy can potentially fasten stabilization of the disease, reduce the need for corticosteroids, and in some patients lead to complete remission. The benefit from thymectomy in MG is supported by propensity score analysis. A randomized control trial looking at the role of thymectomy in nonthymomatous MG patients was recently completed, but the results are not yet available. The approach and extent of thymectomy remain a topic of intense discussion, particularly with the development of minimally invasive surgery. Although the presence of extracapsular thymic tissue is frequent and well described, the accessibility of these ectopic thymic foci as well as their function and impact on outcome after surgery have been unclear, leading to divergent views between proponents of a maximal cervicomediastinal thymectomy with en bloc resection of all fatty tissue between the thyroid grand and the diaphragm and those of a less extensive approach. In the future, better definition of the type of thymectomy will be important, particularly if prospective studies and randomized trials are performed to compare different surgical approaches. One possibility would be to reserve the term "extended thymectomy" to resection of the thymus with the anterior mediastinal fat between both pleura, the pericardium and diaphragm. More extensive surgery should be specified when it encompasses sites such as the right and left pericardiophrenic angles, the aortopulmonary window, the aortocaval groove and retroinnominate space, and the perithyroid area.
Topics: Humans; Myasthenia Gravis; Thymectomy
PubMed: 26880052
DOI: 10.1016/j.jtcvs.2016.01.006 -
The Neurologist Mar 2003Debate continues regarding the effectiveness of thymectomy in the treatment of nonthymomatous autoimmune myasthenia gravis primarily because there have been no... (Review)
Review
BACKGROUND
Debate continues regarding the effectiveness of thymectomy in the treatment of nonthymomatous autoimmune myasthenia gravis primarily because there have been no controlled prospective studies. The debate is compounded by the lack of recognition that all thymectomies are not equal in extent or effectiveness and by the fact that all the studies are retrospective without common definitions of myasthenia gravis manifestations or response to therapy. In addition, the analysis of data is often inappropriate.
REVIEW SUMMARY
Evidence is presented demonstrating that the extent of the various thymic resectional techniques is very variable and often incomplete and that the more complete the thymic resection the better the results. The indications for thymectomy, the selection of the technique of the resection, the reoperations issue, the perioperative management of the myasthenia gravis patient, morbidity and mortality, and appropriate methods of outcome research are also reviewed.
CONCLUSION
In view of the impressive results associated with a complete thymic resection in the treatment of myasthenia gravis, patients should not be denied this operation because of lack of prospective proof to-date, and when a thymectomy is performed a total resection is indicated.
Topics: Humans; Intraoperative Care; Myasthenia Gravis; Reoperation; Thymectomy; Thymus Gland; Treatment Outcome
PubMed: 12808370
DOI: 10.1097/01.nrl.0000051446.03160.2e -
The Annals of Thoracic Surgery Dec 2016A systematic review of the literature was performed to compare long-term outcomes of thymectomy and medical treatment for generalized myasthenia gravis (MG). (Comparative Study)
Comparative Study Review
BACKGROUND
A systematic review of the literature was performed to compare long-term outcomes of thymectomy and medical treatment for generalized myasthenia gravis (MG).
METHODS
A Medline search through June 2015 resulted in 71 studies, 27 of which were selected (10,140 patients: 5,275 thymectomies, 4,865 medication).
RESULTS
The pooled proportion of remission with thymectomy was 0.31 (95% CI, 0.25-0.37), with conservative treatment it was 0.15 (95% CI, 0.12-0.18). The odds ratio (OR) of remission with thymectomy in comparison with medication alone was 2.44 (95% CI, 1.91-3.12) overall and according to medication type and remission definitions.
CONCLUSIONS
Thymectomy is superior to conservative treatment with solely medication on remission in MG.
Topics: Conservative Treatment; Humans; Myasthenia Gravis; Thymectomy; Treatment Outcome
PubMed: 28148454
DOI: 10.1016/j.athoracsur.2016.08.052 -
The Thoracic and Cardiovascular Surgeon Apr 2015
Topics: Humans; Thymectomy
PubMed: 25875857
DOI: 10.1055/s-0035-1549282 -
Interactive Cardiovascular and Thoracic... Aug 2022The aim of this study was to determine the prevalence of nontherapeutic thymectomy and define a clinical standard to reduce it.
OBJECTIVES
The aim of this study was to determine the prevalence of nontherapeutic thymectomy and define a clinical standard to reduce it.
METHODS
From 2016 to 2020, consecutive patients who underwent thymectomy were retrospectively reviewed. Univariable and multivariable analyses were used to identify the correlation factors of nontherapeutic thymectomy. A receiver operating characteristic curve was analysed to assess the cut-off threshold of factors correlated with nontherapeutic thymectomy.
RESULTS
A total of 1039 patients were included in this study. Overall, 78.4% (n = 814) of thymectomies were therapeutic and 21.6% (n = 225) were nontherapeutic. Thymoma (57.9%, n = 602) was the most common diagnosis in therapeutic thymectomy. Among those of nontherapeutic thymectomy, thymic cysts (11.9%, n = 124) were the most common lesion. Compared with therapeutic thymectomy, patients with nontherapeutic thymectomy were more likely to be younger (median age 50.1 vs 55.6 years, P < 0.001) with a smaller precontrast and postcontrast computed tomography (CT) value (P < 0.001, P < 0.001), as well as ΔCT value [10.7 vs 23.5 Hounsfield units (HU), P < 0.001]. Multivariable analysis indicated that only age and ΔCT value were significantly different between therapeutic and nontherapeutic thymectomy groups. Receiver operating characteristic curve analysis showed that cut-off values of age and ΔCT value were 44 years and 6 HU, respectively. Patients with age ≤44 years and a ΔCT value ≤6 HU had a 95% probability of nontherapeutic thymectomy.
CONCLUSIONS
Surgeons should be cautious to perform thymectomy for patients with age ≤44 years and ΔCT value ≤6 HU. This simple clinical standard is helpful to reduce the rate of nontherapeutic thymectomy.
Topics: Adult; Humans; Mediastinal Cyst; Middle Aged; Retrospective Studies; Thymectomy; Thymoma; Thymus Neoplasms
PubMed: 35579357
DOI: 10.1093/icvts/ivac132 -
The Annals of Thoracic Surgery Jun 2010The ideal operative technique for thymectomy in myasthenia gravis remains controversial. Most surgeons perform thymectomy through median sternotomy; more recently,... (Review)
Review
The ideal operative technique for thymectomy in myasthenia gravis remains controversial. Most surgeons perform thymectomy through median sternotomy; more recently, thoracoscopic and robotic approaches have been described. "Extended transcervical thymectomy" is an out-patient procedure that appears less morbid and costly than other approaches. It allows a complete extracapsular thymic resection. Kaplan-Meier complete stable remission rates after transcervical thymectomy are 33% and 35% at 3 and 6 years (higher including patients remaining on single-drug immunosuppression). The major surgical complication rate is 0.7%. We believe that this less morbid and less costly operation is a very reasonable choice in the surgical treatment of myasthenia gravis.
Topics: Humans; Minimally Invasive Surgical Procedures; Myasthenia Gravis; Neck; Thoracic Surgery, Video-Assisted; Thymectomy
PubMed: 20493996
DOI: 10.1016/j.athoracsur.2010.02.099 -
European Journal of Cardio-thoracic... Jun 2022This study aims to compare the surgical outcomes between conventional robotic lateral thymectomy and recently introduced robotic subxiphoid thymectomy (RXT) for the...
OBJECTIVES
This study aims to compare the surgical outcomes between conventional robotic lateral thymectomy and recently introduced robotic subxiphoid thymectomy (RXT) for the surgical treatment of anterior mediastinal tumours.
METHODS
Between May 2008 and July 2020, the patients who underwent robotic thymectomy were included in the study. Because RXT was more frequently performed in the tumours with advanced stages and located in the upper mediastinum abutting the brachiocephalic vein, we conducted propensity score matching to minimize selection bias.
RESULTS
A total of 389 patients (subxiphoid and lateral thymectomy in 188 and 200 patients, respectively) underwent robotic thymectomy, and 141 matched pairs in each group were included in the analysis. After the matching process, both methods showed comparable demographic features, pathological diagnoses and pathologic stages. RXT was performed more frequently for mediastinal masses abutting the brachiocephalic vein (P < 0.01). The proportion of simultaneous resection of adjacent structures, including the lung, pericardium and phrenic nerve, was similar between the 2 groups; however, the proportion of brachiocephalic vein resection was significantly higher in the RXT (P < 0.01). Although both groups showed comparable complication rates (P = 0.80), RXT was associated with shorter hospital stays [2.4 (2.4) vs 3.1 (2.4) days; P = 0.03] and a lower pain score in the immediate and early postoperative periods.
CONCLUSIONS
RXT could be performed safely in complex upper mediastinal tumours abutting the brachiocephalic vein and showed better early outcomes with shorter hospital stays and lesser postoperative pain than robotic lateral thymectomy.
Topics: Humans; Mediastinal Neoplasms; Propensity Score; Retrospective Studies; Robotic Surgical Procedures; Thymectomy; Thymus Neoplasms
PubMed: 35536219
DOI: 10.1093/ejcts/ezac288 -
The Journal of Thoracic and... Jul 2017
Topics: Biomedical Research; Humans; Myasthenia Gravis; Thymectomy; Treatment Outcome
PubMed: 28479053
DOI: 10.1016/j.jtcvs.2016.12.074