Video-assisted thoracoscopic surgery versus sternotomy in treating myasthenia gravis: Comparison by a case-matched study

Absztrakt Célkitűzés: A myasthenia gravis (MG) kezelésében számos nyitott, illetve minimálisan invazív thymectomia ismert. A tanulmány ugyanazon intézeten belül a transsternalis (TS), illetve kétféle minimálisan invazív thymectomia (video-assisted thoracoscopic extended thymectomy – VATET; unilateral video-assisted thoracoscopic surgery – UL-VATS) eredményeit hasonlítja össze. Anyag és módszerek: Három különböző időintervallumban 71 betegnél történt thymectomia MG miatt (60 nő, 11 férfi): 23 transsternalis thymectomia (1995. január–2004. szeptember), 22 VATET (2004. szeptember – 2009. augusztus) és 26 UL-VATS thymectomia (2009. szeptember – 2011. december). Az eredmények értékelésénél a műtéti idő, MG-hez társuló neurológiai és a műtét utáni sebészi szövődmények, valamint az MG státuszában az egyéves utánkövetéskor észlelt neurológiai változások szerepeltek. Eredmények: Perioperatív mortalitás nem fordult elő. A műtéti idő 112, 211, 116 perc (p = 0,001), a kórházi napok száma: 8,9, 5,6 és 4 nap (p = 0,001) volt a TS-, VATET- és UL-VATS-csoportban. Az MG-hez kapcsolódó postoperativ neurológiai szövődmények 21,7%, 18,2% és 7,7% (p = 0,365) értékeket mutattak. A sebészi szövődmény 4,3%, 13,7%, 0% (p = 0,118) volt. Az MG tüneteinek javulása 91,3%, 94,7%, 87,5% (p = 0,712), míg komplett remisszió 13%, 10,5%, 11,5% (p = 0,917) volt a TS-, VATET- és UL-VATS-csoportokban. Következtetések: A műtéti idő, valamint a kórházban eltöltött napok száma UL-VATS esetében volt a legrövidebb. A kisebb sebészi beavatkozáshoz alacsonyabb sebészi, illetve MG-s neurológiai szövődmények társultak. Az MG-tünetek javulásában mindhárom módszernél kiváló eredményt értek el.

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Video-assisted thoracoscopic surgery or transsternal thymectomy in the treatment of myasthenia gravis?

Interactive Cardiovascular and Thoracic Surgery ◽

10.1510/icvts.2010.251041 ◽

2010 ◽

Vol 12 (1) ◽

pp. 40-46 ◽

Cited By ~ 40

Author(s):

I. Zahid ◽

S. Sharif ◽

T. Routledge ◽

M. Scarci

Keyword(s):

Myasthenia Gravis ◽

Thoracoscopic Surgery ◽

Video Assisted ◽

Video Assisted Thoracoscopic Surgery

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Video-assisted thoracoscopic thymectomy for thymoma: a single-center experience

Asian Cardiovascular and Thoracic Annals ◽

10.1177/0218492318759348 ◽

2018 ◽

Vol 26 (3) ◽

pp. 207-211 ◽

Cited By ~ 1

Author(s):

Giang Truong Nguyen ◽

Trung Ngoc Nguyen ◽

Nam Van Nguyen ◽

Kien Trung Nguyen ◽

Anh Viet Le

Keyword(s):

Myasthenia Gravis ◽

Operative Time ◽

Thoracoscopic Surgery ◽

Military Hospital ◽

Video Assisted ◽

Single Center Experience ◽

Early Results ◽

The Mean ◽

Video Assisted Thoracoscopic Surgery

Background Thymoma is a primary tumor derived from the epithelial cells of the thymus, which is commonly seen in the mediastinum. Surgical thymectomy is the radical treatment for thymoma. The recent introduction of video-assisted thoracoscopic surgery has improved the quality of thymectomy surgery. The clinical characteristics of thymoma and the outcomes of video-assisted thoracoscopic thymectomy in Vietnamese patients are still lacking. The objectives of this study were to investigate the clinical and laboratory characteristics of thymoma and to evaluate the early results of video-assisted thoracoscopic thymectomy for thymoma in Vietnamese patients. Methods All 53 thymoma patients with or without myasthenia gravis who underwent video-assisted thoracoscopic thymectomy in Military Hospital 103, Vietnam, from October 2013 to July 2017 were included. Results The mean age was 46.5 7.1 years, and the female/male ratio was 1.2:1. Myasthenia gravis, mostly stage IIA, was present in 84.9% of patients. There was no hospital mortality or major postoperative complication. The mean operative time was 65 min, intensive care unit stay was 22 ± 5 h, and postoperative hospital stay was 7.5 ± 1.7 days. Conclusion Thoracoscopic thymectomy for thymoma in Vietnamese patients achieved improved cosmesis and was safe for both non-myasthenia gravis and myasthenia gravis patients.

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Analysis on the Clinical Effect of High-Dose Glucocorticoids Combined with Immunosuppressants on Patients with Myasthenia Gravis Undergoing Video-Assisted Thoracoscopic Surgery

BioMed Research International ◽

10.1155/2021/5854056 ◽

2021 ◽

Vol 2021 ◽

pp. 1-6

Author(s):

Pei Liu ◽

Haoyue Wang ◽

Jiejie Hu ◽

Xiaobin Zhai ◽

Zhaoming Ge

Keyword(s):

Myasthenia Gravis ◽

Clinical Efficacy ◽

Clinical Effect ◽

Clinical Symptoms ◽

Thoracoscopic Surgery ◽

Control Group ◽

High Dose ◽

Video Assisted ◽

Experimental Group ◽

Video Assisted Thoracoscopic Surgery

Objective. The purpose of the study was to investigate the clinical effect of high-dose glucocorticoids (GCS) combined with immunosuppressants on the treatment of myasthenia gravis (MG) with video-assisted thoracoscopic surgery (VATS). Methods. A total of 106 MG patients admitted to the neurology department of our hospital from February 2016 to February 2020 were selected as the study subjects and divided into experimental group ( n = 53 ) and control group ( n = 53 ). The patients in the control group underwent VATS, while the patients in the experimental group were treated with high-dose GCS combined with immunosuppressants on the basis of VATS treatment. The clinical efficacy of different MG treatment methods was analyzed. Results. No significant differences were observed in visual analogue score (VAS) at T1 between the two groups ( P > 0.05 ), while VAS scores at T2, T3, and T4 in the experimental group were significantly lower than those in the control group ( P < 0.001 ). In the experimental group, the overall response rate was significantly higher than the control group ( P < 0.05 ). Cytotoxic T-lymphocyte-associated protein 4 (CTLA4) level in regulatory T (Treg) cells in experimental groups after treatment was significantly higher, compared to that in before treatment and the control group ( P < 0.05 ). Similar results of each quantitative MG score were displayed in both groups after treatment, compared to before treatment and the control group ( P < 0.05 ). Clinical performance of patients with lower incidence of adverse reactions in the experimental groups after treatment was significantly higher than those in the control group ( P < 0.001 ). Conclusion. GCS combined with immunosuppressants can effectively relieve patients’ clinical symptoms and improve their quality of life, with significant clinical efficacy and high safety, which is worthy of application and promotion.

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Suction Versus Nonsuction Drainage After Uniportal Video-Assisted Thoracoscopic Surgery: A Propensity Score-Matched Study

Frontiers in Oncology ◽

10.3389/fonc.2021.751396 ◽

2021 ◽

Vol 11 ◽

Author(s):

Jian Zhou ◽

Chuan Li ◽

Quan Zheng ◽

Chenglin Guo ◽

Mengyuan Lyu ◽

...

Keyword(s):

Propensity Score ◽

Chest Tube ◽

Thoracoscopic Surgery ◽

Air Leak ◽

Chest Drainage ◽

Video Assisted ◽

Matched Study ◽

Water Seal ◽

Persistent Air Leak ◽

Video Assisted Thoracoscopic Surgery

BackgroundUniportal video-assisted thoracoscopic surgery (UniVATS) was utilized with a rapid growth. The evidence is sparse, however, on whether to add external suction to water-seal drainage for chest drainage after UniVATS. This retrospective propensity score-matched study aimed to identify the necessity of adding external suction to chest drainage after UniVATS.MethodsPatients with lung cancer who underwent UniVATS were included from our prospectively maintained database. Patients were divided into two cohorts based on the addition of external suction to postoperative water-seal drainage or not. Propensity score-matched analysis was performed to identify the impact of suction on chest tube duration, incidence of persistent air leak, hospital stay, and hospitalization cost. Multivariable model with interaction terms was constructed to identify impact of covariables on effect of suction.ResultsThe two cohorts matched well on baseline characteristics (nonsuction: 173; suction: 96). Compared with nonsuction group, suction group showed longer median chest tube duration (3 vs. 2 days, p = 0.003), higher incidences of persistent air leak (9.4% vs. 1.2%, p = 0.003), persistent drainage (16.8% vs. 5.8%, p = 0.007), and reduced drainage volume within first 3 postoperative days (386.90 vs. 504.78 ml, p = 0.011). Resection extent was identified to mediate the relationship between suction and chest tube drainage.ConclusionsThese findings discouraged adding external suction to water-seal drainage after UniVATS regarding longer chest tube duration and more persistent air leak. Patients undergoing lobectomy would benefit more from water-seal drainage without external suction compared with those doing sublobectomy.

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