1.Department of Thoracic Surgery, 2.Department of Neurology,3.Department of Cadre Ward of The PLA Rocket Force Characteristic Medical Center, Beijing 100088, China.
Abstract:Objective To explore the long term results of two types of minimally invasive thymectomy(MIT) for myasthenia gravis(MG).Methods Fifty patients diagnosed with MG underwent video-assisted and robotic-assisted thoracoscopic thymectomy between June 2010 and June 2014 and were followed up till June 2018. The perioperative results of the two groups were analyzed by χ2 test, and the long term effects were evaluated by the Kaplan-Meier method and log-rank test.Results All the patients underwent minimally invasive thymectomy smoothly, with no conversions to thoracotomy or death. A total of 4 cases (8.0%) encountered myasthenic crisis. After 73.3 months of follow-up, the complete remission rate and overall effective rate were 34% (17/50) and 86.0% (43/50) respectively, and there was no significant difference between the two groups. According to Osserman’s criteria, patients classified as type Ⅰ displayed a significant higher effective rate than other groups by univariate analysis. No significant difference was found in the remission rate according to the gender, age, pathology, surgical procedures and the duration of symptoms.Conclusions Video-assisted and robotic-assisted thoracoscopic thymectomy are both safe and feasible for MG patients and may bring about equally favorable prognosis.
Blalock A, Harvey A M, Ford F R, et al. The treatment of myasthenia gravis by removal of the thymus gland: preliminary report[J]. J Am Med Assoc, 1941, 117(18):1529-1533.
Mantegazza R, Baggi F, Antozzi C, et al. Myasthenia gravis (MG): epidemiological data and prognostic factors[J]. Ann NY Acad Sci, 2003, 998(1):413-423.
[8]
Sathasivam S. Current and emerging treatments for the management of myasthenia gravis[J]. Ther Clin Risk Manag, 2011, 7: 313-323.
[9]
Wolfe G I, Kaminski H J, Aban I B, et al. Randomized trial of thymectomy in myasthenia gravis[J]. N Engl J Med, 2016, 375(6):511-522.
Ye B, Tantai J C, Li W, et al. Video-assisted thoracoscopic surgery versus robotic-assisted thoracoscopic surgery in the surgical treatment of Masaoka stage I thymoma[J]. World J Surg Oncol, 2013, 11(1):157.
[13]
Rückert J C, Swierzy M, Ismail M. Comparison of robotic and nonrobotic thoracoscopic thymectomy: a cohort study[J]. J Thorac Cardiov Surg, 2011, 141(3):673-677.
[14]
Buentzel J, Heinz J, Hinterthaner M, et al. Robotic versus thoracoscopic thymectomy: the current evidence [J]. Int J Med Robotics Comput Assist Surg, 2017, 2017:e1847.
Yin D T, Huang L, Han B, et al. Independent long-term result of robotic thymectomy for myasthenia gravis, a single center experience [J]. J Thorac Dis, 2018, 10(1):321-329.
[17]
Ponseti J M, Gamez J, Azem J, et al. Post thymectomy combined treatment of prednisone and tacrolimus versus prednisone alone for consolidation of complete stable remission in patients with myasthenia gravis: a non-randomized, non-controlled study[J]. Curr Med Res Opin, 2007, 23(6):1269-1278.
[18]
Gotterer L, Li Y. Maintenance immunosuppression in myasthenia gravis [J]. J Neurol Sci, 2016, 369: 294-302.
[19]
Cruz J L, Wolff M L, Vanderman A J, et al. The emerging role of tacrolimus in myasthenia gravis [J]. Ther Adv Neurol, 2015, 8(2):92-103.
[20]
Marulli G, Schiavon M, Perissinotto E, et al. Surgical and neurologic outcomes after robotic thymectomy in 100 consecutive patients with myasthenia gravis[J]. J Thorac Cardiov Surg, 2013, 145(3):730-736.