Yujiang Li1,2, Zhenhui Huang2, Wohua Han2, Jingquan Yuan2, Ruiwen Xie2, Guobiao Cheng2, Xi'an Huang2, Yuliang Guo2, Mongying Sun1, Yali Liu1, Xu Wu3, Jianping Zhou4. 1. Department of Thoracic and Cardiovascular Surgery, Huiqiao Medical Center, Nanfang Hospital, Southern Medical University, The First School of Clinical Medicine, Southern Medical University, No. 1838, Guangzhou Avenue North Road, Guangzhou, 510000, China. 2. Department of Thoracic and Cardiovascular Surgery, Affiliated Dongguan People's Hospital, Southern Medical University (Dongguan People's Hospital), No. 3, South of Wandao Road, Wanjiang District, Dongguan, 523000, China. 3. Department of Thoracic and Cardiovascular Surgery, Huiqiao Medical Center, Nanfang Hospital, Southern Medical University, The First School of Clinical Medicine, Southern Medical University, No. 1838, Guangzhou Avenue North Road, Guangzhou, 510000, China. wuxu_southhospital@163.com. 4. Department of Thoracic and Cardiovascular Surgery, Affiliated Dongguan People's Hospital, Southern Medical University (Dongguan People's Hospital), No. 3, South of Wandao Road, Wanjiang District, Dongguan, 523000, China. 987800679@qq.com.
Abstract
PURPOSE: Thymectomy is an important treatment for myasthenia gravis (MG). We conducted this study to compare the clinical outcomes of the recently introduced subxiphoid and subcostal arch thymectomy (SASAT) approach with those of the standard unilateral video-assisted thoracoscopic surgery (VATS). METHODS: We analyzed, retrospectively, the perioperative, and long-term outcomes of 179 consecutive MG patients (age 18-65 years), who underwent SASAT or unilateral VATS-extended thymectomy between July, 2012 and May, 2019. RESULTS: All demographic and clinical characteristics were comparable in the two groups. The median surgical time, estimated blood loss, thoracotomy conversion rate, total and chest drainage, and complications did not differ significantly between the groups. The visual analog scale (VAS) score was significantly lower in the SASAT group. Complete stable remission (CSR) was achieved in a significantly larger proportion of the SASAT group patients and was significantly higher in women than in men. The Quantitative MG score was significantly lower in the SASAT group. Patients in the MG Foundation of America Clinical Classification groups I and II achieved better remission rates than those in groups III-V. CONCLUSIONS: SASAT is a safe and feasible MG treatment, which may yield better outcomes than unilateral VATS and improve the quality of treatment.
PURPOSE: Thymectomy is an important treatment for myasthenia gravis (MG). We conducted this study to compare the clinical outcomes of the recently introduced subxiphoid and subcostal arch thymectomy (SASAT) approach with those of the standard unilateral video-assisted thoracoscopic surgery (VATS). METHODS: We analyzed, retrospectively, the perioperative, and long-term outcomes of 179 consecutive MG patients (age 18-65 years), who underwent SASAT or unilateral VATS-extended thymectomy between July, 2012 and May, 2019. RESULTS: All demographic and clinical characteristics were comparable in the two groups. The median surgical time, estimated blood loss, thoracotomy conversion rate, total and chest drainage, and complications did not differ significantly between the groups. The visual analog scale (VAS) score was significantly lower in the SASAT group. Complete stable remission (CSR) was achieved in a significantly larger proportion of the SASAT group patients and was significantly higher in women than in men. The Quantitative MG score was significantly lower in the SASAT group. Patients in the MG Foundation of America Clinical Classification groups I and II achieved better remission rates than those in groups III-V. CONCLUSIONS: SASAT is a safe and feasible MG treatment, which may yield better outcomes than unilateral VATS and improve the quality of treatment.
Authors: Gil I Wolfe; Henry J Kaminski; Inmaculada B Aban; Greg Minisman; Hui-Chien Kuo; Alexander Marx; Philipp Ströbel; Claudio Mazia; Joel Oger; J Gabriel Cea; Jeannine M Heckmann; Amelia Evoli; Wilfred Nix; Emma Ciafaloni; Giovanni Antonini; Rawiphan Witoonpanich; John O King; Said R Beydoun; Colin H Chalk; Alexandru C Barboi; Anthony A Amato; Aziz I Shaibani; Bashar Katirji; Bryan R F Lecky; Camilla Buckley; Angela Vincent; Elza Dias-Tosta; Hiroaki Yoshikawa; Márcia Waddington-Cruz; Michael T Pulley; Michael H Rivner; Anna Kostera-Pruszczyk; Robert M Pascuzzi; Carlayne E Jackson; Guillermo S Garcia Ramos; Jan J G M Verschuuren; Janice M Massey; John T Kissel; Lineu C Werneck; Michael Benatar; Richard J Barohn; Rup Tandan; Tahseen Mozaffar; Robin Conwit; Joanne Odenkirchen; Joshua R Sonett; Alfred Jaretzki; John Newsom-Davis; Gary R Cutter Journal: N Engl J Med Date: 2016-08-11 Impact factor: 91.245
Authors: Dan M Meyer; Morley A Herbert; Nasin C Sobhani; Paul Tavakolian; Andrea Duncan; Michelle Bruns; Kevin Korngut; Janet Williams; Syma L Prince; L Huber; Gil I Wolfe; Michael J Mack Journal: Ann Thorac Surg Date: 2009-02 Impact factor: 4.330