title: Cellular immunity following video-assisted thoracoscopic and open resection for non-thymomatous myasthenia gravis.
abstract: OBJECTIVE
  Myasthenia gravis (MG) is a common chronic disorder of neuromuscular transmission, frequently treated surgically. Little is known about perioperative cellular immune responses following video-assisted thoracoscopic surgery (VATS) when compared with open resection.
  
  
  METHODS
  Between January and December 2009, 127 patients with non-thymomatous MG underwent surgery, with 54 undergoing VATS and 73 undergoing conventional trans-sternal extended thymectomy (TS). Operative details, ectopic thymic tissue findings, postoperative concentrations of serum immunoglobulin and complement components as well as T-cell immunity were compared in the VATS and TS groups.
  
  
  RESULTS
  There were no between-group differences in patients' age, gender, preoperative duration of MG and operation time. Patients who underwent VATS had a lower rate of postoperative stay in the intensive care unit (P = 0.02), less blood loss (P = 0.01) and a lower probability of ectopic thymic tissue. Prominent cellular immunity difference occurred in serum IgG and C3 concentrations and CD4(+) and CD8(+) T-cell counts between the VATS and TS groups. In VATS patients, serum IgG concentration increased slightly on postoperative days 1 and 3. C3 concentration increased gradually in both groups after surgery, but decreased by postoperative day 7. CD4(+) and CD8(+) T-cell counts were relatively stable postoperatively in the VATS group, but were markedly increased in the TS group on postoperative days 1 and 3, with CD4(+), but not CD8(+), T-cells declining on postoperative day 7.
  
  
  CONCLUSIONS
  VATS for non-thymomatous MG has short-term advantages, with less effect on cellular immune responses than open resection.
authors.affiliation: Department of Thoracic Surgery, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong, China.
authors.forename: Zhenguang
authors.initials: Z
authors.lastname: Chen
authors.forename: Jidong
authors.initials: J
authors.lastname: Zuo
authors.forename: Jianyong
authors.initials: J
authors.lastname: Zou
authors.forename: Yanhong
authors.initials: Y
authors.lastname: Sun
authors.forename: Weibing
authors.initials: W
authors.lastname: Liu
authors.forename: Yingrong
authors.initials: Y
authors.lastname: Lai
authors.forename: Beilong
authors.initials: B
authors.lastname: Zhong
authors.forename: Chunhua
authors.initials: C
authors.lastname: Su
authors.forename: Min
authors.initials: M
authors.lastname: Tan
authors.forename: Honghe
authors.initials: H
authors.lastname: Luo
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002648:Child; D002675:Child, Preschool; D003165:Complement System Proteins / Q000276:immunology; D005260:Female; D006801:Humans; D007111:Immunity, Cellular / Q000276:immunology; D007136:Immunoglobulins / Q000097:blood; D008297:Male; D008875:Middle Aged; D009157:Myasthenia Gravis / Q000276:immunology* / Q000601:surgery*; D011446:Prospective Studies; D013601:T-Lymphocytes / Q000276:immunology; D020775:Thoracic Surgery, Video-Assisted / Q000379:methods*; D013906:Thoracoscopy / Q000379:methods*; D013934:Thymectomy / Q000379:methods*; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D007136:Immunoglobulins; D003165:Complement System Proteins
keywords: Mysthenia gravis; Thoracoscopy/VATS; Thymectomy