title: Video-assisted thoracoscopic extended thymectomy and extended transsternal thymectomy (T-3b) in non-thymomatous myasthenia gravis patients: remission after 6 years of follow-up.
abstract: The aims of this study were to assess the efficacy of video-assisted thoracoscopic extended thymectomy (VATET) as a treatment for myasthenia gravis (MG) and to identify prognostic factors for thymectomy success. Clinical efficacy and variables influencing outcome were assessed by life-table and Cox proportional hazards regression analysis. Complete stable remission (CSR), as defined by the MGFA Medical Task Force, was the end point for efficacy. VATET was performed in 159 MG patients and T-3b in 47 MG patients. At 6 years of follow-up, CSR, assessed by life-table analysis, was 50.6% in non-thymomatous VATET patients and 48.7% in non-thymomatous T-3b surgery. By univariate analysis, the presence of thymic hyperplasia (P=0.0002) and treatment only with anticholinesterases (P<0.0001) were positively associated with the probability of CSR. By multivariate analysis, the chance of complete remission was significantly increased by the use of anticholinesterases (odds ratio [OR] 2.45; 95% confidence interval [CI] 1.44-4.17; P=0.001) and the presence of thymic hyperplasia (OR 1.96; 95% CI 1.05-3.68; P=0.036). VATET seems to be effective in inducing CSR in MG with an efficiency similar to that of the T-3b transsternal (TS) approach; it is easy to perform in experienced hands and is associated with low morbidity and negligible esthetic sequelae.
authors.affiliation: Immunology and Muscular Pathology Unit, Department of Neuromuscular Diseases, Istituto Nazionale Neurologico Carlo Besta Via Celoria 11, 20133 Milan, Italy. rmantegazza@istituto-besta.it
authors.forename: Renato
authors.initials: R
authors.lastname: Mantegazza
authors.forename: Fulvio
authors.initials: F
authors.lastname: Baggi
authors.forename: Pia
authors.initials: P
authors.lastname: Bernasconi
authors.forename: Carlo
authors.initials: C
authors.lastname: Antozzi
authors.forename: Paolo
authors.initials: P
authors.lastname: Confalonieri
authors.forename: Lorenzo
authors.initials: L
authors.lastname: Novellino
authors.forename: Luisella
authors.initials: L
authors.lastname: Spinelli
authors.forename: Maria Teresa
authors.initials: MT
authors.lastname: Ferrò
authors.forename: Ettore
authors.initials: E
authors.lastname: Beghi
authors.forename: Ferdinando
authors.initials: F
authors.lastname: Cornelio
mesh_terms: D000328:Adult; D017668:Age of Onset; D000704:Analysis of Variance; D002800:Cholinesterase Inhibitors / Q000627:therapeutic use; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009157:Myasthenia Gravis / Q000503:physiopathology / Q000601:surgery*; D012044:Regression Analysis; D012074:Remission Induction; D012189:Retrospective Studies; D013647:Task Performance and Analysis; D020775:Thoracic Surgery, Video-Assisted / Q000379:methods*; D013934:Thymectomy; D013950:Thymus Gland / Q000473:pathology; D013952:Thymus Hyperplasia / Q000150:complications; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D002800:Cholinesterase Inhibitors