title: Surgical approaches for stage I and II thymoma-associated myasthenia gravis: feasibility of complete video-assisted thoracoscopic surgery (VATS) thymectomy in comparison with trans-sternal resection.
abstract: Complete resection could be achieved in virtually all myasthenic patients with Masaoka stage I and II thymoma using the trans-sternal technique. Whether this is appropriate for minimally invasive approach is not yet clear. We evaluated the feasibility of complete video-assisted thoracoscopic surgery (VATS) thymectomy for the treatment of Masaoka stage I and II thymoma-associated myasthenia gravis, compared to conventional trans-sternal thymectomy. We summarized 33 patients with Masaoka stage I and II thymoma-associated myasthenia gravis between April 2006 and September 2011. Of these, 15 patients underwent right-sided complete VATS (the VATS group) by using adjuvant pneuomomediastinum, comparing with 18 patients using the trans-sternal approach (the T3b group). No intraoperative death was found and no VATS case required conversion to median sternotomy. Significant differences between the two groups regarding duration of surgery and volume of intraoperative blood loss (P = 0.001 and P < 0.001, respectively) were observed. Postoperative morbidities were 26.7% and 33.3% for the VATS and T3b groups, respectively. All 33 patients were followed up for 12 to 61 months in the study. The cumulative probabilities of reaching complete stable remission and effective rate were 26.7% (4/15) and 93.3% (14/15) in the VATS group, which had a significantly higher complete stable remission and effective rate than those in the T3b group (P = 0.026 and P = 0.000, respectively). We conclude that VATS thymectomy utilizing adjuvant pneuomomediastinum for the treatment of stage I and II thymoma-associated myasthenia gravis is technically feasible but deserves further investigation in a large series with long-term follow-up.
authors.affiliation: Department of Thoracic Surgery;
authors.forename: Zhicheng
authors.initials: Z
authors.lastname: He
authors.forename: Quan
authors.initials: Q
authors.lastname: Zhu
authors.forename: Wei
authors.initials: W
authors.lastname: Wen
authors.forename: Liang
authors.initials: L
authors.lastname: Chen
authors.forename: Hai
authors.initials: H
authors.lastname: Xu
authors.forename: Hai
authors.initials: H
authors.lastname: Li
keywords: adjuvant pneuomomediastinum; myasthenia gravis; thymectomy; thymoma; video-assisted thoracoscopic surgery (VATS)
references.citation: Ann Thorac Surg. 2010 Jun;89(6):S2135-41
references.pmid: 20493997
references.citation: Neurology. 2000 Jul 12;55(1):16-23
references.pmid: 10891897
references.citation: Surg Endosc. 2004 May;18(5):821-4
references.pmid: 15216866
references.citation: Asian Cardiovasc Thorac Ann. 2008 Oct;16(5):366-9
references.pmid: 18812343
references.citation: Eur Surg Res. 2005 Jul-Aug;37(4):199-203
references.pmid: 16260868
references.citation: Ann Thorac Surg. 1994 Aug;58(2):404-7; discussion 407-8
references.pmid: 8067839
references.citation: Asian Cardiovasc Thorac Ann. 2010 Jun;18(3):234-9
references.pmid: 20519290
references.citation: Ann Thorac Surg. 2003 Oct;76(4):1310-1
references.pmid: 14530043
references.citation: Eur J Cardiothorac Surg. 2009 May;35(5):812-6; discussion 816
references.pmid: 19237289
references.citation: J Neurol Sci. 2003 Aug 15;212(1-2):31-6
references.pmid: 12809996
references.citation: Chest. 2005 Nov;128(5):3454-60
references.pmid: 16304299
references.citation: Rev Mal Respir. 1988;5(2):173-8
references.pmid: 3293128
references.citation: Ann Thorac Surg. 2012 Jan;93(1):240-4
references.pmid: 21978875
references.citation: Eur J Cardiothorac Surg. 2010 Jan;37(1):7-12
references.pmid: 19615918
references.citation: J Neuroimmunol. 2008 Sep 15;201-202:237-44
references.pmid: 18722676
references.citation: J Thorac Cardiovasc Surg. 1996 Nov;112(5):1352-9; discussion 1359-60
references.pmid: 8911334
references.citation: Ann Thorac Surg. 2000 May;69(5):1537-41
references.pmid: 10881838
references.citation: Thorac Surg Clin. 2011 Feb;21(1):125-9, viii
references.pmid: 21070994
references.citation: Eur J Cardiothorac Surg. 2010 Apr;37(4):824-6
references.pmid: 19913436
references.citation: Ann Thorac Surg. 2009 Feb;87(2):385-90; discussion 390-1
references.pmid: 19161744
references.citation: Chest. 2005 Oct;128(4):3010-2
references.pmid: 16236980
references.citation: Ann Thorac Surg. 2009 Jun;87(6):1973-80
references.pmid: 19463649
references.citation: Cancer. 1981 Dec 1;48(11):2485-92
references.pmid: 7296496
references.citation: Eur J Cardiothorac Surg. 2002 Dec;22(6):978-83
references.pmid: 12467823
references.citation: Chest. 1995 Nov;108(5):1440-3
references.pmid: 7587454