Comparison of different types of thymectomy for the treatment of thymoma with myasthenia gravis_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

TANG Guiwang ^1,2 , YE Jingting ¹ , WU Qiang ¹ , TANG Shanwei ¹ ,  SHU Yusheng ¹

1. Department of Thorac-Cardiac Surgery, Northern Jiangsu People's Hospital, Yangzhou, 225001, Jiangsu, P.R.China;
2. Department of Thorac-Cardiac Surgery, Xiangya No.2 Hospital of Central South University, Changsha, 410000, P.R.China;

Corresponding?author：

SHU Yusheng, Email: shuyusheng65@163.com

Keywords：

Thymoma; myasthenia gravis; thoracoscopy combined with mediastinoscopy; thymectomy

DOI：

10.7507/1007-4848.201711029

Video：

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Objective To compare the different surgical treatment methods of thymoma combined with myasthenia gravis (MG), and to discuss the clinical effectiveness of thoracoscopic combined mediastinoscopic extended thymectomy. Methods We retrospectively analyzed the clinical data of 58 patients of thymoma combined with myasthenia gravis in Northern Jiangsu People's Hospital between 2011 and 2016 year. According to the operation method, the patients were divided into three groups including a group A for thoracoscopic thymectomy (n=32), a group B for thoracoscopic combined mediastinoscopic thymectomy (n=15), and a group C for transsternal thymectomy (n=11). The clinical effects were observed and compared. Results In the group A and the group B, the bleeding volume, postoperative hospital stay and other complications were significantly lower than those in the group C with statistical differences (P<0.05). The incidence of myasthenic crisis in the group B (6.7%) was less than that in the group C (36.4 %), but the difference was not statistically different (P=0.058). The operation time of the three groups was 122.0 ± 39.4 min, 130.3 ± 42.5 min, and 142.3 ± 40.8 min respectively with no statistical difference between the two groups (P>0.05). The rate of dissection grade in the group B (grade 1, 12 patients, 80%) was significantly greater than that in the group A (grade 1, 14 patients, 43.8%,P<0.05). The effective rate of the group A, the group B, the group C was 84.4%, 93.3% and 90.9%, respectively with no statistical difference between groups (P>0.05). Conclusion The thoracoscopy combined mediastinoscopic thymectomy not only has the advantages of less trauma, quicker recovery and fewer complications, but also can more thoroughly clean the thymus and adipose tissue, which can achieve the same therapeutic effect as the transsternal thymectomy.

Citation： TANG Guiwang, YE Jingting, WU Qiang, TANG Shanwei, SHU Yusheng. Comparison of different types of thymectomy for the treatment of thymoma with myasthenia gravis. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2018, 25(9): 767-771. doi: 10.7507/1007-4848.201711029 Copy

1.	Marx A, Weis CA, Str?bel P. Thymomas. Pathologe, 2016, 37(5): 412-424.
2.	Toker A, Sonett J, Zielinski M, et al. Standard terms, definitions, and policies for minimally invasive resection of thymoma. J Thorac Oncol, 2011, 6(7): S1739.
3.	束余聲, 孫超, 陸世春. 電視縱隔鏡下經頸小切口行胸腺切除治療小兒重癥肌無力. 中華小兒外科雜志, 2011, 32(7): 481-483.
4.	Raza A, Woo E. Video-assisted thoracoscopic surgery versus sternotomy in thymectomy for thymoma and myasthenia gravis. Ann Cardiothorac Surg, 2016, 5(1): 33-37.
5.	Agatsuma H, Yoshida K, Yoshino I, et al. Video-assisted rhoracic aurgery rhymectomy versus sternotomy thymectomy in patients with thymoma. Ann Thorac Surg, 2017, 104(3): 1047-1053.
6.	張文軍, 范軍, 馬冬春, 等. 胸腔鏡與胸骨正中劈開胸腺擴大切除治療重癥肌無力并胸腺瘤的比較. 安徽醫科大學學報, 2016, 51(5): 755-758.
7.	齊瑞. 胸腔鏡與開胸手術治療重癥肌無力合并胸腺瘤的隨機對照研究. 中國醫學工程, 2015, 9(23): 79-81.
8.	Yang SB, Mao-Yong FU, Jie-Wei HU, et al. Analysis of the efficacy and safety of video assisted thoracic surgery and thoracic surgery in the treatment of myasthenia gravis. Prog Modern Biomed, 2017, 17(23): 4583-4585.
9.	Yu L, Ma S, Jing Y, et al. Combined unilateral-thoracoscopic and mediastinoscopic thymectomy. Ann Thorac Surg, 2010, 90(6): 2068-2070.
10.	Rd JA, Barohn RJ, Ernstoff RM, et al. Myasthenia gravis: recommendations for clinical research standards. Task Force of the Medical Scientific Advisory Board of the Myasthenia Gravis Foundation of America. Neurology, 2000, 55(1): 16-23.
11.	Rd JA, penn AS, Younger DS, et al. "Maximal" thymectomy for myasthenia gravis. Results. Korean J Thorac Cardiovasc Surg, 1988, 95(5): 747.
12.	劉宇, 束余聲. 胸腺切除術后發生肌無力危象危險因素的 Meta 分析. 中華胸心血管外科雜志, 2015, 31(11): 660-664.
13.	Zielinski M, Kuzdzal J, Szlubowski A, et al. Comparison of late results of basic transsternal and extended transsternal thymectomies in the treatment of myasthenia gravis. Ann Thorac Surg, 2004, 78(1): 253.
14.	錢昆杰, 孫清超, 李德生, 等. 胸腺瘤合并重癥肌無力患者術后遠期療效及影響因素分析. 中國胸心血管外科臨床雜志, 2016, 23(7): 698-701.
15.	Chao YK, Liu YH, Hsieh MJ, et al. Long-term outcomes after thoracoscopic resection of stage Ⅰ and Ⅱ thymoma: a propensity-matched study. Ann Surg Oncol, 2015, 22(4): 1371-1376.
16.	惠剛, 烏達, 陳保坤, 等. 胸腔鏡擴大切除胸腺及胸腺瘤治療重癥肌無力. 廣州醫學院學報, 2013, 41(1): 41-43.
17.	Gu ZT, Mao T, Chen WH, et al. Comparison of video-assisted thoracoscopic surgery and median sternotomy approaches for thymic tumor resections at a single institution. Surg Laparosc Endosc Percutan Tech, 2015, 25(1): 47-51.
18.	Caronia FP, Arrigo E, Trovato S, et al. Uniportal bilateral video-assisted sequential thoracoscopic extended thymectomy. J Vis Surg, 2017, 3(1): 69.
19.	于磊, 馬山, 王天佑, 等. 胸腔鏡聯合縱隔鏡胸腺擴大切除治療重癥肌無力. 中華外科雜志, 2010, 48(6): 474-475.
20.	Lin Q, Zhang Y, Yang L. Single-center retrospective analysis of 162 cases with thymoma complicating myastheniagravis. J BUON, 2017, 22(3): 741-745.
21.	繆乾兵, 石維平, 束余聲, 等. 重癥肌無力的外科治療和圍術期處理. 中國醫師雜志, 2010, 12(11): 1504-1505.

1. Marx A, Weis CA, Str?bel P. Thymomas. Pathologe, 2016, 37(5): 412-424.
2. Toker A, Sonett J, Zielinski M, et al. Standard terms, definitions, and policies for minimally invasive resection of thymoma. J Thorac Oncol, 2011, 6(7): S1739.
3. 束余聲, 孫超, 陸世春. 電視縱隔鏡下經頸小切口行胸腺切除治療小兒重癥肌無力. 中華小兒外科雜志, 2011, 32(7): 481-483.
4. Raza A, Woo E. Video-assisted thoracoscopic surgery versus sternotomy in thymectomy for thymoma and myasthenia gravis. Ann Cardiothorac Surg, 2016, 5(1): 33-37.
5. Agatsuma H, Yoshida K, Yoshino I, et al. Video-assisted rhoracic aurgery rhymectomy versus sternotomy thymectomy in patients with thymoma. Ann Thorac Surg, 2017, 104(3): 1047-1053.
6. 張文軍, 范軍, 馬冬春, 等. 胸腔鏡與胸骨正中劈開胸腺擴大切除治療重癥肌無力并胸腺瘤的比較. 安徽醫科大學學報, 2016, 51(5): 755-758.
7. 齊瑞. 胸腔鏡與開胸手術治療重癥肌無力合并胸腺瘤的隨機對照研究. 中國醫學工程, 2015, 9(23): 79-81.
8. Yang SB, Mao-Yong FU, Jie-Wei HU, et al. Analysis of the efficacy and safety of video assisted thoracic surgery and thoracic surgery in the treatment of myasthenia gravis. Prog Modern Biomed, 2017, 17(23): 4583-4585.
9. Yu L, Ma S, Jing Y, et al. Combined unilateral-thoracoscopic and mediastinoscopic thymectomy. Ann Thorac Surg, 2010, 90(6): 2068-2070.
10. Rd JA, Barohn RJ, Ernstoff RM, et al. Myasthenia gravis: recommendations for clinical research standards. Task Force of the Medical Scientific Advisory Board of the Myasthenia Gravis Foundation of America. Neurology, 2000, 55(1): 16-23.
11. Rd JA, penn AS, Younger DS, et al. "Maximal" thymectomy for myasthenia gravis. Results. Korean J Thorac Cardiovasc Surg, 1988, 95(5): 747.
12. 劉宇, 束余聲. 胸腺切除術后發生肌無力危象危險因素的 Meta 分析. 中華胸心血管外科雜志, 2015, 31(11): 660-664.
13. Zielinski M, Kuzdzal J, Szlubowski A, et al. Comparison of late results of basic transsternal and extended transsternal thymectomies in the treatment of myasthenia gravis. Ann Thorac Surg, 2004, 78(1): 253.
14. 錢昆杰, 孫清超, 李德生, 等. 胸腺瘤合并重癥肌無力患者術后遠期療效及影響因素分析. 中國胸心血管外科臨床雜志, 2016, 23(7): 698-701.
15. Chao YK, Liu YH, Hsieh MJ, et al. Long-term outcomes after thoracoscopic resection of stage Ⅰ and Ⅱ thymoma: a propensity-matched study. Ann Surg Oncol, 2015, 22(4): 1371-1376.
16. 惠剛, 烏達, 陳保坤, 等. 胸腔鏡擴大切除胸腺及胸腺瘤治療重癥肌無力. 廣州醫學院學報, 2013, 41(1): 41-43.
17. Gu ZT, Mao T, Chen WH, et al. Comparison of video-assisted thoracoscopic surgery and median sternotomy approaches for thymic tumor resections at a single institution. Surg Laparosc Endosc Percutan Tech, 2015, 25(1): 47-51.
18. Caronia FP, Arrigo E, Trovato S, et al. Uniportal bilateral video-assisted sequential thoracoscopic extended thymectomy. J Vis Surg, 2017, 3(1): 69.
19. 于磊, 馬山, 王天佑, 等. 胸腔鏡聯合縱隔鏡胸腺擴大切除治療重癥肌無力. 中華外科雜志, 2010, 48(6): 474-475.
20. Lin Q, Zhang Y, Yang L. Single-center retrospective analysis of 162 cases with thymoma complicating myastheniagravis. J BUON, 2017, 22(3): 741-745.
21. 繆乾兵, 石維平, 束余聲, 等. 重癥肌無力的外科治療和圍術期處理. 中國醫師雜志, 2010, 12(11): 1504-1505.

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Comparison of different types of thymectomy for the treatment of thymoma with myasthenia gravis

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