title: Video-assisted thoracoscopic surgery thymectomy versus open thymectomy in patients with myasthenia gravis: a meta-analysis.
abstract: BACKGROUND
  Video-assisted thoracoscopic surgery (VATS) thymectomy has become a feasible treatment for myasthenia gravis (MG) in recent years. The objective of the present meta-analysis was to evaluate the perioperative characteristics, safety, and completely stable remission rate in patients with MG who received VATS or open thymectomy (OT).
  
  
  METHODS
  We searched PubMed, Embase, ScienceDirect, Web of Science, and CNKI for related articles using combinations of the search terms video-assisted thoracoscopic thymectomy, transsternal thymectomy, and MG. The inter-study heterogeneity was assessed by χ2-based Q statistics, and the extent of inconsistency was generated by I2statistics.
  
  
  RESULTS
  A total of 12 studies with 1173 patients were included, and there was no difference in the operation time (p = 0.08) and ICU time (p = 0.14) between the two groups, but VATS thymectomy was associated with less intra-operation blood loss and hospital time (p < 0.00001). VATS was also associated with lower rates of total complication (OR =0.59; 95% CI, 0.37-0.94; p = 0.03) and myasthenic crisis (OR = 0.51; 95% CI, 0.28-0.92; p = 0.03), but the rates of pneumonia (OR = 0.59; 95% CI, 0.29-1.32; p = 0.21) and complete remission rate (CSR) (OR = 0.64; 95% CI, 0.38-1.09; p = 0.10) had no obvious differences between the VATS and OT groups.
  
  
  CONCLUSIONS
  Patients with MG undergoing VATS thymectomy achieved better surgical outcomes and fewer complications than those who received OT.
authors.affiliation: a Department of Thoracic Surgery , Chinese PLA General Hospital , Beijing , P.R. China.
authors.forename: Kang
authors.initials: K
authors.lastname: Qi
authors.affiliation: a Department of Thoracic Surgery , Chinese PLA General Hospital , Beijing , P.R. China.
authors.forename: Bo
authors.initials: B
authors.lastname: Wang
authors.affiliation: a Department of Thoracic Surgery , Chinese PLA General Hospital , Beijing , P.R. China.
authors.forename: Bin
authors.initials: B
authors.lastname: Wang
authors.affiliation: a Department of Thoracic Surgery , Chinese PLA General Hospital , Beijing , P.R. China.
authors.forename: Lian-Bin
authors.initials: LB
authors.lastname: Zhang
authors.affiliation: a Department of Thoracic Surgery , Chinese PLA General Hospital , Beijing , P.R. China.
authors.forename: Xiang-Yang
authors.initials: XY
authors.lastname: Chu
mesh_terms: D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007902:Length of Stay; D008297:Male; D009157:Myasthenia Gravis / Q000175:diagnosis / Q000601:surgery*; D061646:Operative Time; D011183:Postoperative Complications / Q000453:epidemiology / Q000503:physiopathology; D018570:Risk Assessment; D056346:Sternotomy / Q000009:adverse effects / Q000379:methods*; D020775:Thoracic Surgery, Video-Assisted / Q000009:adverse effects / Q000379:methods*; D013934:Thymectomy / Q000009:adverse effects / Q000379:methods*; D013945:Thymoma / Q000175:diagnosis / Q000601:surgery*; D016896:Treatment Outcome
keywords: Meta-analysis; myasthenia gravis; thymectomy; video-assisted thoracoscopic surgery