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The Journal of Thoracic and... Nov 2012
Topics: Female; Humans; Male; Neoplasms, Glandular and Epithelial; Robotics; Surgery, Computer-Assisted; Thoracic Surgery, Video-Assisted; Thymectomy; Thymus Neoplasms
PubMed: 22944086
DOI: 10.1016/j.jtcvs.2012.07.092 -
Revue Medicale de Liege Jul 2020We report the story of an 11-year-old girl admitted to the emergency room for diplopia and divergent squint. Promptly apparead a fluctuating ptosis, a nasal voice and...
We report the story of an 11-year-old girl admitted to the emergency room for diplopia and divergent squint. Promptly apparead a fluctuating ptosis, a nasal voice and swallowing disorders, evoking the diagnosis of autoimmune myasthenia. The latter has been confirmed with electromyogram. Treatment with corticoids, plasmapheresis and pyridostigmine allowed symptoms control. Thymectomy by left thoracoscopy, non-robot assisted, was performed 6 months after the appearance of the first clinical signs for the purpose of remission.
Topics: Adrenal Cortex Hormones; Child; Diplopia; Female; Humans; Myasthenia Gravis; Thoracoscopy; Thymectomy
PubMed: 32779904
DOI: No ID Found -
Ugeskrift For Laeger Jan 2020This review summarises the diagnostics, staging and treatment of thymic epithelial tumours, of which CT is the current primary imaging. The International Association for... (Review)
Review
This review summarises the diagnostics, staging and treatment of thymic epithelial tumours, of which CT is the current primary imaging. The International Association for the Study of Lung Cancer/International Thymic Malignancy Interest Group TNM staging and the WHO histological classifications are described. Surgery done as total thymectomy with video-assisted thoracoscopic surgery in stage I and open sternotomy in larger stages is the primary treatment if possible. Presurgical tumour reduction with chemotherapy and the possibility of adjuvant radiotherapy after R+ resection is described. Radiotherapy or chemotherapy can be considered, if definite surgery is not possible. Relapse is treated after the same principles as primary disease.
Topics: Humans; Neoplasm Recurrence, Local; Neoplasm Staging; Neoplasms, Glandular and Epithelial; Retrospective Studies; Thymectomy; Thymoma; Thymus Neoplasms
PubMed: 31928621
DOI: No ID Found -
Cancer Control : Journal of the Moffitt... Jul 2015Tumors of the mediastinum as well as normal thymus glands in patients with myasthenia gravis have traditionally been resected using large and morbid incisions. However,... (Review)
Review
BACKGROUND
Tumors of the mediastinum as well as normal thymus glands in patients with myasthenia gravis have traditionally been resected using large and morbid incisions. However, robotic-assisted mediastinal resections are gaining popularity because of the many advantages that the robot provides. However, few comprehensive reviews of the literature on robotic-assisted mediastinal resections exist.
METHODS
A systemic review of the current medical literature was performed, excluding cases related to esophageal pathology. These studies were evaluated and their findings are reported in this comprehensive review. Approximately 48 papers met the inclusion criteria for review.
RESULTS
Robotic-assisted surgical systems are increasingly being used in mediastinal resections. Based on the available literature, robotic-assisted thoracoscopic surgery in the mediastinum is feasible and safe. Robotic-assisted mediastinal surgery appears to be superior to open approaches of the mediastinum and is comparable with videothoracoscopic surgery when patient outcomes are considered.
CONCLUSIONS
Increased robotic experience and more studies, including randomized controlled trials, are needed to validate the findings of the current literature.
Topics: Humans; Mediastinal Neoplasms; Robotic Surgical Procedures; Thoracic Surgery, Video-Assisted; Thymectomy
PubMed: 26351888
DOI: 10.1177/107327481502200310 -
The International Journal of Medical... Dec 2021Recently, thymectomy using minimally invasive approaches has been increasing with the development of robotic video-assisted thoracoscopic surgery (R-VATS). Although... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Recently, thymectomy using minimally invasive approaches has been increasing with the development of robotic video-assisted thoracoscopic surgery (R-VATS). Although multimodal approach is effective for robot assisted thymectomy, it is necessary to determine the approach (left, right or subxiphoid) associated with the least complications.
METHODS
An electronic retrieval from PubMed, Embase, Web of Science, GreyNet International and The Cochrane Library. The single-arm meta-analysis was performed to compare the rate of complications of right- and left-side approaches by R-VATS.
RESULTS
A total of 21 studies including 930 patients were identified. The pooled incidence of total complications was 12.2% (confidence interval: 10.0%-14.8%) for all studies. The overall complication rate was 17.3% for the right-side compared with 7.4% for the left side (P < 0.001, odds ratio = 2.484, 1.601-3.852). The pooled incidence of air leak was significantly higher for the right versus left side (5.1% vs. 1.2%, respectively; p = 0.004). The incidence of atrial fibrillation was higher for the right-side compared with the left-side approach (4% vs. 1.2%, respectively; p = 0.004). The open conversion rate was significantly higher for the right versus the left-side (6.5% vs. 2.9%, respectively; p = 0.004). However, there was no significant difference in the pooled incidence of pleural effusion and thoracic duct fistula when comparing the right- and left-side approaches. In subgroup analysis, in the left approach, the incidence of overall complications (28.6% vs. 5.5%, respectively; p = 0.002) and pleural effusion (14.3% vs. 1%, respectively; p = 0.002) was higher for the 'Old Age' group compared with the 'Youth' group; However, In the subgroup analysis of gender, there was no significant difference in the incidence of complications after thymectomy.
CONCLUSION
Robotic video-assisted thoracoscopic surgery can be performed on the left- and right-sides; however, complications are minimal with the left-side approach. These data demonstrate that the incidence of overall complications, atrial fibrillation, open conversion ratios, and air leak rate of left-side R-VATS thymectomy are lower than those of right-side. Further subgroup analysis showed that the incidence of postoperative complications was higher in the older group.
Topics: Adolescent; Humans; Postoperative Complications; Robotics; Thoracic Surgery, Video-Assisted; Thymectomy; Treatment Outcome
PubMed: 34533876
DOI: 10.1002/rcs.2333 -
Interactive Cardiovascular and Thoracic... Feb 2022We investigated the efficacy of subxiphoid thoracoscopic thymectomy in patients with myasthenia gravis. The data of 37 consecutive cases were reviewed. 2 cases of...
We investigated the efficacy of subxiphoid thoracoscopic thymectomy in patients with myasthenia gravis. The data of 37 consecutive cases were reviewed. 2 cases of postoperative myasthenia gravis crisis and 4 cases of residual mediastinal fat tissue were recorded. Moreover, 29 patients presented the neurological outcomes, and complete stable remission was achieved in 5 (17.2%) cases. Subxiphoid thymectomy is technically feasible. High-quality evidence is warranted before this approach can be recommended.
Topics: Disease Progression; Humans; Myasthenia Gravis; Postoperative Period; Thoracic Surgery, Video-Assisted; Thymectomy; Treatment Outcome
PubMed: 34626192
DOI: 10.1093/icvts/ivab262 -
The Lancet. Neurology Mar 2019The Thymectomy Trial in Non-Thymomatous Myasthenia Gravis Patients Receiving Prednisone (MGTX) showed that thymectomy combined with prednisone was superior to prednisone... (Clinical Trial)
Clinical Trial Randomized Controlled Trial
BACKGROUND
The Thymectomy Trial in Non-Thymomatous Myasthenia Gravis Patients Receiving Prednisone (MGTX) showed that thymectomy combined with prednisone was superior to prednisone alone in improving clinical status as measured by the Quantitative Myasthenia Gravis (QMG) score in patients with generalised non-thymomatous myasthenia gravis at 3 years. We investigated the long-term effects of thymectomy up to 5 years on clinical status, medication requirements, and adverse events.
METHODS
We did a rater-blinded 2-year extension study at 36 centres in 15 countries for all patients who completed the randomised controlled MGTX and were willing to participate. MGTX patients were aged 18 to 65 years at enrolment, had generalised non-thymomatous myasthenia gravis of less than 5 years' duration, had acetylcholine receptor antibody titres of 1·00 nmol/L or higher (or concentrations of 0·50-0·99 nmol/L if diagnosis was confirmed by positive edrophonium or abnormal repetitive nerve stimulation, or abnormal single fibre electromyography), had Myasthenia Gravis Foundation of America Clinical Classification Class II-IV disease, and were on optimal anticholinesterase therapy with or without oral corticosteroids. In MGTX, patients were randomly assigned (1:1) to either thymectomy plus prednisone or prednisone alone. All patients in both groups received oral prednisone at doses titrated up to 100 mg on alternate days until they achieved minimal manifestation status. The primary endpoints of the extension phase were the time-weighted means of the QMG score and alternate-day prednisone dose from month 0 to month 60. Analyses were by intention to treat. The trial is registered with ClinicalTrials.gov, number NCT00294658. It is closed to new participants, with follow-up completed.
FINDINGS
Of the 111 patients who completed the 3-year MGTX, 68 (61%) entered the extension study between Sept 1, 2009, and Aug 26, 2015 (33 in the prednisone alone group and 35 in the prednisone plus thymectomy group). 50 (74%) patients completed the 60-month assessment, 24 in the prednisone alone group and 26 in the prednisone plus thymectomy group. At 5 years, patients in the thymectomy plus prednisone group had significantly lower time-weighted mean QMG scores (5·47 [SD 3·87] vs 9·34 [5·08]; p=0·0007) and mean alternate-day prednisone doses (24 mg [SD 21] vs 48 mg [29]; p=0·0002) than did those in the prednisone alone group. 14 (42%) of 33 patients in the prednisone group, and 12 (34%) of 35 in the thymectomy plus prednisone group, had at least one adverse event by month 60. No treatment-related deaths were reported during the extension phase.
INTERPRETATION
At 5 years, thymectomy plus prednisone continues to confer benefits in patients with generalised non-thymomatous myasthenia gravis compared with prednisone alone. Although caution is appropriate when generalising our findings because of the small sample size of our study, they nevertheless provide further support for the benefits of thymectomy in patients with generalised non-thymomatous myasthenia gravis.
FUNDING
National Institutes of Health, National Institute of Neurological Disorders and Stroke.
Topics: Adult; Female; Humans; Longitudinal Studies; Male; Myasthenia Gravis; Prednisone; Thymectomy; Treatment Outcome; Young Adult
PubMed: 30692052
DOI: 10.1016/S1474-4422(18)30392-2 -
Journal of Thoracic Oncology : Official... Jan 2016Complete resection is the standard of care for treatment of thymic malignancies. The use of minimally invasive surgery remains controversial. We searched online... (Comparative Study)
Comparative Study Meta-Analysis Review
Complete resection is the standard of care for treatment of thymic malignancies. The use of minimally invasive surgery remains controversial. We searched online databases and identified studies from 1995 to 2014 that compared minimally invasive to open thymectomy for thymic malignancies. Study end points included operative blood loss, operative time, respiratory complications, cardiac complications, length of hospital stay, R0 resection, and recurrence. We summarized outcomes across studies using random-effects meta-analysis to account for study heterogeneity. We calculated ORs for binary outcomes and standardized mean differences for continuous outcomes. We calculated incidence rate ratios for the number of recurrences, accounting for total person-time observed in each study. Of 516 potential reference studies, 30 with a total of 2038 patients met the inclusion criteria. Patients with Masaoka stage I or II thymic malignancy constituted 94.89% of those in the minimally invasive surgery (MIS) group and 78.62% of those in open thymectomy (open) group. Mean tumor size was 4.09 cm (MIS) versus 4.80 (open). Of the 1355 MIS cases, 32 were converted to open cases. Patients in the MIS group had significantly less blood loss; however, no significant differences in operating time, respiratory complications, cardiac complications, or overall complications were identified. Length of stay was shorter for patients in the MIS group. When patients with Masaoka stage I and II thymic malignancy only were analyzed, there was no difference in rate of R0 resection or overall recurrence rate. One postoperative death occurred in the open group. The results of this unadjusted meta-analysis of published reports comparing minimally invasive with open thymectomy suggest that in selected patients with thymic malignancy, minimally invasive thymectomy is safe and can achieve oncologic outcomes similar to those of open thymectomy.
Topics: Humans; Minimally Invasive Surgical Procedures; Risk Assessment; Thymectomy; Thymoma; Thymus Neoplasms
PubMed: 26762737
DOI: 10.1016/j.jtho.2015.08.004 -
Annals of Surgery Aug 1996The authors identify criteria suitable to predict long-term clinical improvement and evaluate quality of life after thymectomy for myasthenia. (Review)
Review
OBJECTIVE
The authors identify criteria suitable to predict long-term clinical improvement and evaluate quality of life after thymectomy for myasthenia.
DESIGN
Retrospective analysis with long-term follow-up (mean 92 months) was conducted for 86 patients and questionnaire interviews were performed for 65 patients who underwent thymectomy between 1976 and 1993.
MAIN OUTCOME MEASURES
The authors used the Osserman Score and the European Organization for Research and Treatment of Cancer quality-of-life questionnaire.
RESULTS
After thymectomy, lasting benefits were achieved predominantly by patients with moderate and severe myasthenia, and this association was significant (p < 0.001) in both bivariable and multiple analyses. No correlation was observed between outcome and thymic pathology, patient age or gender, duration of disease, preoperative plasmapheresis, and medication. Restitution to normal was complete at most recent follow-up as to physical status, working ability, and cognitive and social functions, but some emotional and vegetative deficits remained.
CONCLUSION
Future patient selection for thymectomy should-apart from those with suspected thymoma-concentrate on patients with moderate and severe myasthenia unresponsive to conservative management.
Topics: Adult; Aged; Female; Follow-Up Studies; Humans; Male; Middle Aged; Myasthenia Gravis; Quality of Life; Retrospective Studies; Surveys and Questionnaires; Thymectomy; Time Factors
PubMed: 8757388
DOI: 10.1097/00000658-199608000-00017 -
Asian Journal of Surgery Jun 2021Myasthenia gravis is a rare autoimmune disease caused by antibodies that probably originate from the thymus glands. This study examined the epidemiology of patients with... (Observational Study)
Observational Study
BACKGROUND
Myasthenia gravis is a rare autoimmune disease caused by antibodies that probably originate from the thymus glands. This study examined the epidemiology of patients with MG, who underwent thymectomy over the last three decades.
METHODS
The objectives of this observational study were to investigate the clinicopathological features, treatment modalities, and prognostic factors for patients with thymic masses, over three decades at the Royal Hospital, Muscat, Oman.
RESULTS
There were 100 patients who underwent thymectomy with a mean (SD) age of 32.0 (8.6) years, of which 20% were men and 80% were women. Their follow up period, cardiac and neurology clinics, ranged from 1.5 to 12.0 years with a mean (SD) of 6.0 (3.0) years. Small percentage of MG patients had diabetes and hypertension and 10% of patients have positive family history of MG. Symptoms at the onset of the disease were ophthalmoplegia in 75%, limb weakness in 39%, bulbar symptoms in 57% and respiratory symptoms in 39% of patients. The Osserman grading was Grade I - 5%, Grade IIA - 39%, Grade IIB - 34%, and Grade III - 22%. Post thymectomy, 21% of patients had complete clinical remission, 76% of patients had significant clinical improvement and 3% had no apparent improvement in their clinical status. Histologically, hyperplasia was found in 57% and involuted thymus in 18% of patients.
CONCLUSION
Thymectomy can reduce patient's need for medication and reduce the severity of MG regardless of age, sex, severity, or length of sickness, or thymic masses. The early-onset, sever M.G, female, thymic hyperplasia benefit the most. Patients classified as Osserman Class IIA and IIB benefit most from this procedure.
Topics: Adult; Female; Humans; Hyperplasia; Male; Myasthenia Gravis; Remission Induction; Thymectomy; Thymus Gland
PubMed: 33579606
DOI: 10.1016/j.asjsur.2020.12.013