Comparative analysis of variants of surgical approach in treatment of thymic tumors (meta-analysis)

Dmitrochenko, I. V.; Дзидзава, И. И.; Котив, Б. Н.; Fufaev, E E; Yasyuchenya, D. A.; Чуприна, А. П.; Barinov, O V; Leonovich, A. P.; Bisenkov, L N; Shalaev, Sergey

doi:10.24884/0042-4625-2017-176-5-106-110

VESTNIK KHIRURGII IMENI I.I.GREKOVA

2017

DOI: 10.24884/0042-4625-2017-176-5-106-110

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Comparative analysis of variants of surgical approach in treatment of thymic tumors (meta-analysis)

I. V. Dmitrochenko

И. И. Дзидзава

Б. Н. Котив

et al.

Abstract: ОБЗОРЫЭпителиальные опухоли вилочковой железы (тимомы и карциномы) являются самыми частыми первичными новообразованиями переднего средостения и нередко сочетаются с различными аутоиммунными заболеваниями и паранеопластическими синдромами [17,18,25,26,30,32]. Тимэктомия является необходимым условием эффективного лечения опухолей вилочковой железы [33,34]. В последнее время все чаще появляются сообщения о выполнении тимэктомии из торакоскопического доступа при удовлетворительных показателях онкологической эффект… Show more

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Cited by 4 publications

References 30 publications

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Comparative analysis of the long-term surgical treatment results of noninvasive thymus gland tumors

Levchenko,

Dzidzava,

Dmitrochenko

et al. 2023

Bulletin of the Russian Military Medical Academy

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The study compared the long-term results of thymectomy from traditional open thoracic/sternotomic and endovideosurgical access in 98 patients with thymus tumors. All patients were divided into two groups depending on the thymectomies performed from various surgical approaches. The control group consisted of 34 patients in whom surgical interventions were performed via the traditional open access, and the main group consisted of 29 patients in whom surgical interventions were performed via the endovideosurgical access. Both groups were comparable by sex, age, concomitant pathology, presence, and severity of clinical signs of myasthenia gravis, tumor size, morphological structure, and progression stage according to the classifications by Masaoka-Koga (1997) and TNM-8 2017. According to the frequency of tumor recurrence and regression of myasthenic disorders within 3 years after surgery, no significant differences were found between the groups (2 (5.9%) and 0, p = 0.27; 9 (69.2%) and 10 (71.4%), p = 0.52, respectively). Moreover, no significantly significant differences were found in the long-term survival (so-called KaplanMeier survival function) between the two groups. The annual, 3-, 5- and 10-year survival rates in the control group were 100%, 90.3% 2%, 87% 4%, and 87% 4%, and in the video-assisted thymectomy group, the survival rates were 100%, 100%, 100%, and 92.3% 3%, respectively (p = 0.71). In general, the long-term results of endovideosurgical thymectomy with small tumors and the absence of invasion into neighboring anatomical structures do not differ from those of traditional open surgical interventions in terms of the main oncological indicators, namely, long-term survival and frequency of tumor recurrence. The obtained results are consistent with world literature data, according to which the most significant prognostic factor of long-term survival is the stage of tumor progression by TNM. The average 5-year survival rates following radical thymectomy were 90%, 90%, 60%, and 25%, respectively, for TNM stages I, II, III, and IV.

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Comparative analysis of the long-term surgical treatment results of noninvasive thymus gland tumors

Levchenko,

Dzidzava,

Dmitrochenko

et al. 2023

Bulletin of the Russian Military Medical Academy

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Operative approaches for thymectomy: clinical characteristics and classification variant

Dmitrochenko,

Levchenko,

Dzidzava

2023

Bulletin of the Russian Military Medical Academy

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Currently, surgical intervention is the gold standard treatment of thymus tumors. Radical removal of the thymus gland in a single block, including the tumor, adjacent lymph nodes, and surrounding tissue of the anterior mediastinum, is a prerequisite for achieving satisfactory immediate and long-term results. The need for maximum thymectomy together with anterior mediastinal fiber is attributed to the fact that, along with other long-term survival factors (stage of tumor progression and histological subtype of the tumor), 4550% of deaths in the long-term follow-up period are due to the recurrence of thymoma and 1520% are caused by a progressive course of myasthenia gravis. The results of domestic and foreign studies on the implementation of thymectomy from various surgical approaches are analyzed. These include traditional thoracotomy and sternotomy, video-assisted and robot-assisted interventions, and combined operative accesses. The data presented are based on systematic reviews, retrospective cohort studies, clinical cases, and experimental studies using text databases PubMed, Google Scholar, and eLibrary.ru. The clinical characteristics of each operative access are given with an emphasis on technical features and advantages and disadvantages of thymectomy. The immediate results of surgical treatment of patients with thymus gland neoplasms are presented. Additional methods of visualization and physical preparation of anterior mediastinal tissues are described separately, which help increase the safety and effectiveness of surgical intervention. Currently, low-traumatic video-assisted surgical interventions are widely used in thoracic surgery, gradually replacing traditional open operations. Nevertheless, the variety of proposed options for surgical access, lack of clear indications and contraindications to various interventions on the thymus gland, and discrepancies in the use of various terms determine the need to develop a modern classification of surgical accesses for performing thymectomy. Taking into account world literature data and our own experience, a classification of operative accesses for performing thymectomy is proposed.

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Minimally invasive techniques in thymic surgery (review of literature)

Пикин

Рябов

Martynova

et al. 2021

VESTNIK KHIRURGII IMENI I.I.GREKOVA

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We carried out the systematic review of the domestic and foreign literature focusing on surgical treatment of patients with thymic pathology. Special attention was paid to the discussion of the advantages of minimally invasive surgery, particularly, video endoscopic thymectomy from subxiphoid access. Pubmed, Medline and E-library databases were searched for retrospective and prospective randomized trials. Based on the analysis of literature sources, we presented the data on tumor and non-tumor pathology of the thymus gland, clarified indications for surgical treatment in different types of thymic pathology. Variants of thymectomy were described, a brief historical review of the use of the surgical method in patients with thymus gland pathology was conducted. The technique of surgeries, advantages and weak points of various surgical approaches were described. We focused our attention on minimally invasive interventions, listed its advantages in comparison with the standard “open” surgical approach. The contemporary trends in surgical approaches in thymus pathology were discussed. Minimally invasive thymectomy is modern, safe and feasible variant of surgical treatment of patients with tumor and non-tumor pathology of the thymus gland. The subxiphoid approach allows to reduce postoperative pain, provides an excellent view of mediastinal structures and both pleural cavities, which improves the safety of operation with satisfactory cosmetic results.

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Comparative analysis of variants of surgical approach in treatment of thymic tumors (meta-analysis)

Cited by 4 publications

References 30 publications

Comparative analysis of the long-term surgical treatment results of noninvasive thymus gland tumors

Comparative analysis of the long-term surgical treatment results of noninvasive thymus gland tumors

Operative approaches for thymectomy: clinical characteristics and classification variant

Minimally invasive techniques in thymic surgery (review of literature)

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