Surgical treatment of mediastinal tumors combined with myasthenia gravis: comparison of Da Vinci robot-assisted, video-assisted thoracoscopic surgery and median sternotomy_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

KANG Yunteng , XU Shiguang , LIU Bo , WANG Xilong , XU Wei , DING Renquan , LI Bo , WANG Tong , LIU Xingchi , MENG Hao , TENG Hong ,  WANG Shumin

Department of Thoracic Surgery, General Hospital of Shenyang Military Command, Shenyang, 110000, P.R.China;

Corresponding?author：

WANG Shumin, Email: sureman2003congo@163.com

Keywords：

Myasthenia gravis; extended thymectomy; robotic surgery; thoracoscopy; median sternotomy

DOI：

10.7507/1007-4848.201804072

Video：

Export PDF Favorites Scan Get Citation

Abstract Full text Figures/Tables Video References Cited by

Objective To compare three surgical treatments for mediastinal mass with myasthenia gravis. Methods Retrospective analysis was performed on the clinical data of 53 patients who underwent extended thymectomy between January 2010 and December 2017 in our hospital. There were 29 males and 24 females, aged 17-73 years. Patients were divided into three groups according to the surgical methods: a group A (video-assisted thoracoscopic surgery with the da Vinci robotic system, n=22), a group B (video-assisted thoracoscopic surgery, n=12) and a group C (median sternotomy, n=19). The gender distribution, age, intraoperative blood loss, operation time, postoperative extubation time, postoperative hospital stay, Osserman classification of myasthenia gravis, postoperative myasthenic remission rate, etc were compared in three groups. Results No perioperative death was observed in 53 patients. One patient in the group C suffered from postoperative myasthenic crisis and improved after active treatment. One patient with video-assisted thoracoscopic surgery was converted to median sternotomy due to the intraoperative injury of the left brachiocephalic vein. Compared with the group B and group C, the group A had shorter operation time, less intraoperative blood loss and drainage on the first postoperative day and fewer days of extubation. Postoperative hospital stay was less in the group A than that in the group C (P<0.05). The postoperative myasthenic remission rate was higher in the group A than that in the other two groups, but there was no statistical difference. Conclusion Because of the robot’s unique minimally invasive advantage, in this study, the outcome of patients with myasthenia gravis treated with Da Vinci robots and thymectomy is better than that of the remaining two groups in terms of perioperative outcomes and myasthenic remission rate. But long-term results and a large of number matching experiments are needed to confirm. However, it is undeniable that robotic surgery must be the future of the minimally invasive surgery.

Citation： KANG Yunteng, XU Shiguang, LIU Bo, WANG Xilong, XU Wei, DING Renquan, LI Bo, WANG Tong, LIU Xingchi, MENG Hao, TENG Hong, WANG Shumin. Surgical treatment of mediastinal tumors combined with myasthenia gravis: comparison of Da Vinci robot-assisted, video-assisted thoracoscopic surgery and median sternotomy. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2018, 25(12): 1027-1031. doi: 10.7507/1007-4848.201804072 Copy

1.	Schumacher R, Roth JJ. Thymektomie bei cenem fall vonmorbus basedowii mit myasthenia. Med Chir, 1912, 25: 746.
2.	中國免疫學會神經免疫學分會, 中華醫學會神經病學分會神經免疫學組. 重癥肌無力診段和治療中國專家共識. 中國神經免疫學和神經病學雜志, 2012, 19(6): 401-408.
3.	Benatar M, Kaminski HJ, Quality Standards Subcommittee of the American Academy of Neurology. Evidence report: the medical treatment of ocular myasthenia(an evidence-based review): report of the Quality Standards Subcommittee of the American Academy of Neurology. Neurology, 2007, 68(24): 2144-2149.
4.	Skeie GO, Apostolski S, Evoli A, et al. Guidelines for treatment of autoimmune neuromuscular transmission disorders. Eur J Neurol, 2010, 17(7): 893-902.
5.	Jaretzki A 3rd, 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. Ann Thorac Surg, 2000, 70(1): 327-334.
6.	李瑾, 尚珂. 重癥肌無力患者胸腺切除術后發生肌無力危象的危險因素分析. 內科急危重癥雜志, 2016, 22(4): 297-299.
7.	劉會平, 李劍鋒, 吳怡成, 等. 電視胸腔鏡胸腺擴大切除治療重癥肌無力 107 例臨床分析. 中華外科雜志, 2005, 43(10): 625-627.
8.	Goldstein SD, Yang SC. Assessment of robotic thymectomy using the Myasthenia Gravis Foundation of America Guidelines. Ann Thorac Surg, 2010, 89(4): 1080-1085.
9.	王述民, 李博, 許世廣, 等. 達芬奇機器人在胸腺擴大切除術治療Ⅰ型重癥肌無力的應用. 中國胸心血管外科臨床雜志, 2013, 20(6): 679-682.
10.	中華醫學會神經病學分會神經免疫學組, 中國免疫學會神經免疫學分會. 中國重癥肌無力診斷和治療指南 2015. 中華神經科雜志, 2015, 48(11): 934-940.
11.	王述民, 許世廣, 童向東, 等. 達芬奇機器人手術系統在胸外科縱隔腫瘤切除術中的應用體會. 臨床軍醫雜志, 2013, 41(12): 1247-1249.
12.	Wang S, Xu S, Liu B. Resection of huge retrosternal goiter through a novel combined cervical and robot-assisted approach. Artif Organs, 2014, 38(5): 431-433.
13.	劉星池, 許世廣, 徐惟, 等. 完全無管化達芬奇機器人縱隔腫瘤切除手術在快速康復外科中應用. 臨床軍醫雜志, 2016, 44(6): 569-570.
14.	Skeie GO, Apostolski S, Evoli A, et al. Guidelines for treatment of autoimmune neuromuscular transmission disorders. Eur J Neurol, 2010, 17(7): 893-902.
15.	Gilhus NE. Myasthenia gravis. N Engl J Med, 2017, 376(13): e25.
16.	Cakar F, Werner P, Augustin F, et al. A comparison of outcomes after robotic open extended thymectomy for myasthenia gravis. Eur J Cardiothorac Surg, 2007, 31(3): 501-504.
17.	Taioli E, Paschal PK, Liu B, et al. Comparison of conservative treatment and thymectomy on myasthenia gravis outcome. Ann Thorac Surg, 2016, 102(6): 1805-1813.
18.	Meyer DM, Herbert MA, Sobhani NC, et al. Comparative clinical outcomes of thymectomy for myasthenia gravis performed by extended transsternal and minimally invasive approaches. Ann Thorac Surg, 2009, 87(2): 385-390.
19.	Savcenko M, Wendt GK, Prince SL, et al. Video-assisted thymectomy for myasthenia gravis: an update of a single institution experience. Eur J Cardiothorac Surg, 2002, 22(6): 978-983.
20.	Rowse PG, Roden AC, Corl FM, et al. Minimally invasive thymectomy: the Mayo Clinic experience. Ann Cardiothorac Surg, 2015, 4(6): 519-526.
21.	許世廣, 王述民. 做好達芬奇機器人肺葉切除手術前的準備工作—一個助手的經驗分享. 實用醫院臨床雜志, 2015, 12(1): 35-38.

1. Schumacher R, Roth JJ. Thymektomie bei cenem fall vonmorbus basedowii mit myasthenia. Med Chir, 1912, 25: 746.
2. 中國免疫學會神經免疫學分會, 中華醫學會神經病學分會神經免疫學組. 重癥肌無力診段和治療中國專家共識. 中國神經免疫學和神經病學雜志, 2012, 19(6): 401-408.
3. Benatar M, Kaminski HJ, Quality Standards Subcommittee of the American Academy of Neurology. Evidence report: the medical treatment of ocular myasthenia(an evidence-based review): report of the Quality Standards Subcommittee of the American Academy of Neurology. Neurology, 2007, 68(24): 2144-2149.
4. Skeie GO, Apostolski S, Evoli A, et al. Guidelines for treatment of autoimmune neuromuscular transmission disorders. Eur J Neurol, 2010, 17(7): 893-902.
5. Jaretzki A 3rd, 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. Ann Thorac Surg, 2000, 70(1): 327-334.
6. 李瑾, 尚珂. 重癥肌無力患者胸腺切除術后發生肌無力危象的危險因素分析. 內科急危重癥雜志, 2016, 22(4): 297-299.
7. 劉會平, 李劍鋒, 吳怡成, 等. 電視胸腔鏡胸腺擴大切除治療重癥肌無力 107 例臨床分析. 中華外科雜志, 2005, 43(10): 625-627.
8. Goldstein SD, Yang SC. Assessment of robotic thymectomy using the Myasthenia Gravis Foundation of America Guidelines. Ann Thorac Surg, 2010, 89(4): 1080-1085.
9. 王述民, 李博, 許世廣, 等. 達芬奇機器人在胸腺擴大切除術治療Ⅰ型重癥肌無力的應用. 中國胸心血管外科臨床雜志, 2013, 20(6): 679-682.
10. 中華醫學會神經病學分會神經免疫學組, 中國免疫學會神經免疫學分會. 中國重癥肌無力診斷和治療指南 2015. 中華神經科雜志, 2015, 48(11): 934-940.
11. 王述民, 許世廣, 童向東, 等. 達芬奇機器人手術系統在胸外科縱隔腫瘤切除術中的應用體會. 臨床軍醫雜志, 2013, 41(12): 1247-1249.
12. Wang S, Xu S, Liu B. Resection of huge retrosternal goiter through a novel combined cervical and robot-assisted approach. Artif Organs, 2014, 38(5): 431-433.
13. 劉星池, 許世廣, 徐惟, 等. 完全無管化達芬奇機器人縱隔腫瘤切除手術在快速康復外科中應用. 臨床軍醫雜志, 2016, 44(6): 569-570.
14. Skeie GO, Apostolski S, Evoli A, et al. Guidelines for treatment of autoimmune neuromuscular transmission disorders. Eur J Neurol, 2010, 17(7): 893-902.
15. Gilhus NE. Myasthenia gravis. N Engl J Med, 2017, 376(13): e25.
16. Cakar F, Werner P, Augustin F, et al. A comparison of outcomes after robotic open extended thymectomy for myasthenia gravis. Eur J Cardiothorac Surg, 2007, 31(3): 501-504.
17. Taioli E, Paschal PK, Liu B, et al. Comparison of conservative treatment and thymectomy on myasthenia gravis outcome. Ann Thorac Surg, 2016, 102(6): 1805-1813.
18. Meyer DM, Herbert MA, Sobhani NC, et al. Comparative clinical outcomes of thymectomy for myasthenia gravis performed by extended transsternal and minimally invasive approaches. Ann Thorac Surg, 2009, 87(2): 385-390.
19. Savcenko M, Wendt GK, Prince SL, et al. Video-assisted thymectomy for myasthenia gravis: an update of a single institution experience. Eur J Cardiothorac Surg, 2002, 22(6): 978-983.
20. Rowse PG, Roden AC, Corl FM, et al. Minimally invasive thymectomy: the Mayo Clinic experience. Ann Cardiothorac Surg, 2015, 4(6): 519-526.
21. 許世廣, 王述民. 做好達芬奇機器人肺葉切除手術前的準備工作—一個助手的經驗分享. 實用醫院臨床雜志, 2015, 12(1): 35-38.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Surgical treatment of mediastinal tumors combined with myasthenia gravis: comparison of Da Vinci robot-assisted, video-assisted thoracoscopic surgery and median sternotomy

Abstract Full text Figures/Tables Video References Cited by

Previous Article

Next Article

Format

Content