Purpose: Transsternal thymectomy is well established in the treatment of myasthenia gravis (MG). The objectives of this study were to evaluate the influence and prognostic factors of thymectomy as treatment for MG.
Patients And Methods: Surgical results of 54 patients with MG who underwent transsternal thymectomy were retrospectively reviewed. We investigated clinical outcomes of extended transsternal thymectomy in MG, and we analyzed the data to clarify the effect of prognostic factors on clinical outcome.
Results: A total of 54 patients, including 28 males and 26 females, were analyzed. At their last visit, 5 patients (9%) were in complete remission; 36 (67%) reported clinical improvement; and 18 (33%) had no change. There were no operative or late deaths. Clinical improvement was not detected by a patient's age, sex, presence or absence of thymoma, or acetylcholine receptor (AchR) antibodies titer. Patients in which the duration of illness before operation was equal to or less than 24 months (p = 0.018), and patients in the advanced Myasthenia Gravis Foundation of America (MGFA) stage (p = 0.014), showed a greater degree of clinical improvement.
Conclusion: Transsternal thymectomy for MG is safe and effective. Those patients with severe symptoms and a shorter duration of illness showed more benefits from thymectomy.
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J Thorac Dis
October 2024
Department of Cardiothoracic Surgery, Weill Cornell Medical Center/New York Presbyterian Hospital, New York, NY, USA.
Background: Robotic-assisted thoracoscopic surgery (RATS) is widely accepted for small-to-moderate-size thymomas. However, limited data exists comparing the feasibility of RATS for large tumors ≥5 cm. The aim of this study is to compare the oncological and perioperative outcomes of open thymectomy (OT) versus RATS for these larger tumors.
View Article and Find Full Text PDFGen Thorac Cardiovasc Surg
October 2024
Department of Thoracic Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumai-Cho, Showa-Ku, Nagoya, 466-8550, Japan.
Objective: Following the introduction of robot-assisted thoracoscopic surgery (RATS) as a health insurance-covered treatment in Japan, we investigated the current status and impact of the expansion of the indications for RATS for mediastinal tumors.
Methods: Between 2018 and 2022, 209 cases of total mediastinal tumor resection were performed in our hospital. The study period was divided into the first half (January 2018 to June 2020) and the second half (July 2020 to December 2022), and perioperative parameters were compared between the two groups.
J Cardiothorac Surg
September 2024
Gastrointestinal Research Center, Kerman University of Medical Sciences, Kerman, Iran.
Background: Myasthenia gravis is an autoimmune disease with high prevalence of thymus disorders, in which, thymectomy is considered one of the therapeutic approaches in improving the patients' clinical outcomes. Today, thoracoscopic thymectomy has received significant attention than the classic transsternal approach due to fewer complication. Therefore, this study was designed with the aim of investigating the therapeutic outcomes of thymectomy in patients with myasthenia gravis in the Afzalipour Hospital of Kerman between 2011 and 2021.
View Article and Find Full Text PDFNeurol Clin Pract
October 2024
Department of Neurology (JM, LZ, GTL, SJB, AGH), Perelman School of Medicine, University of Pennsylvania, Philadelphia; Division of Neuromuscular Medicine (ACG), Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston; Department of Ophthalmology (GTL, AGH); Division of Thoracic Surgery (SS), Department of Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia; Department of Neurology (GIW), Jacobs School of Medicine and Biomedical Sciences, State University at Buffalo/SUNY, NY; and Department of Biostatistics, Epidemiology, and Informatics (AGH), Perelman School of Medicine, University of Pennsylvania, Philadelphia.
Background And Objectives: In 2016, a randomized controlled trial demonstrated the clinical efficacy of trans-sternal thymectomy for patients with non-thymomatous myasthenia gravis (MG). Whether large-scale changes occurred in clinical practice after this trial is unknown.
Methods: We performed a retrospective longitudinal cross-sectional analysis using National Inpatient Sample (NIS) data from 2012 to 2019.
Mediastinum
February 2024
Division of Pediatric Surgery, Department of Surgery, Northwestern University Feinberg School of Medicine, Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA.
Background And Objective: Thymectomy as a management strategy for juvenile myasthenia gravis (JMG) has been increasingly adopted with the advent of minimally invasive surgical techniques. This review evaluates existing evidence regarding the surgical management of JMG, including the benefits of surgical compared to medical therapy, important considerations when evaluating surgical candidacy and determining optimal timing of intervention. In addition, we provide an overview of the open, thoracoscopic and robotic surgical approaches available for thymectomy and compare the existing data to characterize optimal surgical management.
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