The neurological outcome of patients with myasthenia gravis underwent thymectomy via sternotomy and video assisted thoracoscopic surgery (VATS) (original) (raw)
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European Journal of Cardio-Thoracic Surgery, 2001
We reviewed our overall experience on 163 patients, affected by myasthenia gravis, who underwent thymectomy between 1976 and 1998. A comparison between the oldest series of 72 patients (January 1976±December 1992), referred by various neurologists and operated on through different approaches, and the last 91 patients (January 1993±December 1998), taking part in a strict diagnostictherapeutical programme, was made. Methods: Anagraphic data, duration of symptoms, the surgical approach, necessity of respiratory assistance, the hospital stay, histopathological ®ndings, preoperative and postoperative Osserman classi®cation, as well as medications, were globally analyzed and then compared in the two groups. Results: Signi®cant differences in the length of hospitalization (8.7 days vs.. 4.2 days; P 0:00001) and in the prolonged intubation rate (18 vs. 0; P , 0:000001) were observed in the most recent series. Patients in the preoperative Osserman stage I and operated on in the second period had a higher complete remission rate at the univariate analysis (P , 0:001 and P , 0:0001, respectively). At the multivariate analysis the only parameter which affected the outcome was to be operated on in the second period (P , 0:01). Conclusions: Our experience con®rms the role of the extended thymectomy in the treatment of myasthenia gravis. Whenever an extended thymectomy was performed through a complete sternotomy it was a quick procedure, with short hospitalization and acceptable cosmetic results. A careful pharmacological control of the myastenic symptoms and the presence of teamwork among neurologist, thoracic surgeon and anaesthesist in the peri-operative setting reduce the incidence of complications and might increase the ef®cacy of the thymectomy.
Experience of thymectomy by median sternotomy in patients with myasthenia gravis
JPMA. The Journal of the Pakistan Medical Association, 2010
To determine the outcome of thymectomy in patients with myasthenia gravis and safety of median sternotomy approach. An observational descriptive study was conducted in the department of thoracic surgery JPMC from February 2005 to January 2009. Twenty-two patients having persistent generalized or ocular myasthenia gravis referred to our department by neurologists and general physicians, partially or not responding to medical treatment with or without thymoma, were included in the study. Those who were not fit for anaesthesia were excluded. Preoperatively 2 to 3 sessions of plasmapheresis were done and each patient was given anti myasthenia gravis treatment. Clinical staging was done by Modified Osserman classification. Median sternotomy approach was used. Outcome was assessed on the basis of remission of disease in different Osserman groups. All patients were followed for a minimum of 6 months. Out of 22 patients, 16 (72.7%) were females and 6 (27.2%) males. Mean age at presentation ...
Video-Assisted Thoracoscopic Thymectomy for Myasthenia Gravis
Chest, 1995
Thymectomy has long been considered one of the treatment modalities for myasthenia gravis (MG). The centre of debate has been the surgical technique for thymectomy, such as complete, extended and maximal thymectomies, and the surgical approach with the transsternal approach being the most common. Partial sternal splitting was the gold standard approach for many decades with less postoperative complications and safety. Transcervical thymectomy and video-assisted thoracoscopic surgery (VATS) thymectomy gained popularity for superior cosmesis, less invasive approach, shorter hospital stays and increased safety. Both techniques may provide a complete removal of the thymus gland. Now, different VATS techniques are preferred by different surgeons and clinics. The debate is shifting to the options of an extended thymectomy or a bigger thymus resection with minimally invasive techniques. Robotic thymectomy, which is considered a robot-assisted VATS thymectomy, became an important choice for surgical treatment in several centres. In this study, we aimed to study the role of thymectomy in the treatment of MG, including debatable indications and recently developed attitudes for the difficult decisions, and the effects of recent technology on the outcome of MG treatment.
Interactive CardioVascular and Thoracic Surgery, 2010
A best evidence topic in thoracic surgery was written according to a structured protocol. The question addressed was how video-assisted thoracoscopic surgery (VATS) compares to median sternotomy in the surgical management of patients with myasthenia gravis (MG)? Overall 74 papers were found using the reported search, of which 15 represented the best evidence to answer the clinical question. The authors, journal, date and country of publication, patient group studied, study type, relevant outcomes and results are tabulated. We conclude that VATS produces equivalent postoperative mortality and complete stable remission (CSR) rates, with superior results in terms of hospital stay, operative blood loss and patient satisfaction at the expense of a doubling of operative time. Six studies comparing VATS and transsternal sternotomy in non-thymomatous myasthenia gravis (NTMG) patients found VATS to have lower operative blood loss (73.8"70.7 vs. 155.3"91.7 ml; P-0.05), reduced total hospital stay (5.6"2.2 vs. 8.1"3.0 days; Ps0.008), whilst maintaining equivalent remission rates (33 vs. 44.7%; Ps0.16) and mass of thymic tissue resection (37 vs. 34 g; P)0.05). One study comparing video-assisted thoracoscopic extended thymectomy to transsternal thymectomy in only thymoma-associated myasthenia gravis (T-MG) patients found equivalent CSR (11.3 vs. 8.7%, Ps0.1090) at six-year follow-up. Thymoma recurrence rate (9.64%) was not significantly different (Ps0.1523) between the two groups. Eight studies comparing VATS and transsternal approach in mixed T-MG and NTMG patients found a lower hospital stay (1.9"2.6 vs. 4.6"4.2 days, P-0.001), reduced need for postoperative medication (76.5 vs. 35.7%, Ps0.022), lower intensive care unit stay (1.5 vs. 3.2 days, Ps0.018), greater symptom improvement (100 vs. 77.9%, Ps0.019) and better cosmetic satisfaction (100 vs. 83, Ps0.042) with VATS. In concordance with NTMG and T-MG alone patient groups, VATS and transsternal methods had equivalent complication rates (23 vs. 19%, Ps0.765) with no mortalities in either group. Even though VATS has a longer operative time (268"51 vs. 177"92 min, P-0.05), its improved cosmesis, reduced need for postoperative medication and equivalent disease resolution outcomes make it a preferable surgical option to the transsternal approach.
Video-Assisted Thoracic Surgery Thymectomy for Nonthymomatous Myasthenia Gravis
Chest, 2005
Study objectives: Minimal-access thymectomy has become increasingly popular as surgical treatment for patients with nonthymomatous myasthenia gravis (NTMG) because of its comparable efficacy, safety, and lesser degree of tissue trauma compared with conventional open surgery. We reviewed and analyzed our data on video-assisted thoracic surgery (VATS) thymectomy and present the clinical outcomes according to the Myasthenia Gravis Foundation of America classification. Design: A retrospective review of VATS thymectomy for NTMG in a university hospital over a 12-year period. Data were collected from the medical records and supplemented with telephone surveys. The impact of surgery and other variables potentially affecting complete stable remission (CSR) were calculated using Kaplan-Meier survival curves; comparisons between survival curves was performed using the log-rank test. Results: A total of 38 consecutive patients underwent VATS thymectomy for NTMG. Median postoperative stay was 3 days. Pathologic examination revealed thymic hyperplasia in 61.1% of cases, normal thymus in 22.2%, and thymic atrophy in 16.6%. There was no perioperative mortality; complications occurred in four patients. After a median follow-up of 69 months, 91.6% of patients experienced improvement, with crude CSR achieved in 22.2%. Kaplan-Meier survival curve demonstrated a 75% CSR rate at 10-year follow-up. On univariate analysis, only disease duration < 12 months (p ؍ 0.03) was associated with a statistically significant improvement in CSR. Conclusions: VATS thymectomy for NTMG results in symptomatic improvement in the vast majority of patients, with a high rate of CSR. The procedure is associated with low morbidity and no perioperative mortality. Future studies on thymectomy for myasthenia gravis should be reported in a standardized manner to allow accurate comparisons between results in the absence of randomized prospective trials.
Outcome and Complications of Trans-Sternal Thymectomy for Myasthenia Gravis
Journal of Islamic International Medical College, 2016
Objective: To determine outcome and postoperative complications of trans-sternal thymectomy for myasthenia gravis. Study Design: Experimental, prospective. Place and Duration of Study: The study was conducted at Department of Surgery, Pakistan Institute of Medical Sciences (PIMS), Islamabad from June 2009 to June 2012. Materials and Methods: We included 30 consecutive patients from all age groups either coming to Surgical outpatient clinic or referred from Neurolgy unit having generalized myasthenia gravis between 12-55 years of age, thymic mass on radiology or poor medical control of disease with no contra indications to surgery. Patients unfit for anaesthesia due to any reason or inoperable thymic tumour were excluded. We studied outcome and post-operative complications in all patients after total thymectomy through trans-sternal approach for 24-40 months. All patients were assessed for haemorrhage, transfusion requirement, shock, myasthenia crisis, respiratory infection, wound in...
Thoracoscopic thymectomy for myasthenia gravis: a case report
Annals of the Academy of Medicine, Singapore, 1998
Total thymectomy combined with medical therapy is currently the most effective therapeutic strategy for patients with myasthenia gravis. The standard approach for total thymectomy is that of a median sternotomy. Other approaches include the cervical approach and partial sternotomy. We report a patient who underwent video-assisted thoracoscopic thymectomy at our institution. There was no postoperative complications and the patient was discharged on the fifth postoperative day. Video-assisted thoracoscopic thymectomy has proved to be an effective surgical therapy for the treatment of myasthenia gravis. The long-term outcome awaits close follow-up of the patients operated using this technique.
Results of video-assisted thymectomy in patients with myasthenia gravis
The Journal of Thoracic and Cardiovascular Surgery, 1996
Objective: The efficacy of video-assisted thoracic surgery for thymectomy with myasthenia gravis has not been examined. Methods: Thirty-three consecutive patients underwent total thymectomy by video-assisted techniques between 1992 and 1995. There were 13 male and 20 female patients with a mean age of 38.42 --16.88 years (range 9 to 84 years). The procedures were performed by either a right (n = 11) or left (n = 22) thoracoscopic approach and all anterior mediastinal tissue was removed. Results: There was no perioperative mortality or long-term morbidity. One patient required conversion of the video.assisted thechnque to a lateral thoracotomy. All patients except one were extubated immediately. The mean hospital stay was 4.12 --6.07 days (range 1 to 37 days) with a median of 3 days. Mean follow-up is 23.39 -11.72 months (range 4 to 47 months). Clinical improvement was seen in 87.9% (29/33): one of two patients (50%) in stage I, 17 of 19 (89.4%) in stage IIA, eight of nine (88.8%) in stage IIB, and three of three (100%) in stage III. Metaanalysis of these results compared with results in nine published series in which other techniques were used showed no difference in clinical improvement after thymectomy between series. Conclusion: We conclude that video-assisted thymectomy is as effective as the traditional open surgical approaches for performance of thymectomy in the management of patients with myasthenia gravis. In addition, the improved cosmesis of the video-assisted approach ideally will lead to earlier thymectomy in patients with myasthenia gravis. (J Thorac Cardiovasc Surg 1996;112:1352-60)
International Surgery Journal
Background: Myasthenia gravis (MG) is an autoimmune disease affecting acetylcholine postsynaptic receptor of voluntary muscles. Thymectomy is a mainstay in the treatment for myasthenia gravis with or without thymoma. For many years transsternal and transcervical thymectomy had been the most common approaches used, video assisted thoracoscopic thymectomy is still not accepted as approach of choice. We intend to study the role of Video assisted thoracoscopic thymectomy for myasthenia gravis in central Indian population.Methods: Study was conducted in single tertiary care institute from January 2015 to November 2018. It is a prospective study. Aims of the study were to evaluate the safety and feasibility of video assisted thoracoscopic thymectomy for patients of myasthenia gravis. All patients of myasthenia gravis who underwent underwent video assisted thoracoscopic thymectomy (VATS) were included in the study. Intraoperative and postoperative details were studied to assess the safety ...