Matched-pair comparison of three different approaches for thymectomy in myasthenia gravis

Rückert, Jens-C.; Sobel, H. K.; Göhring, Stefan; Einhäupl, Karl M.; Müller, J. M.

doi:10.1007/s00464-002-9162-6

Cited by 34 publications

(6 citation statements)

References 20 publications

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“…Two studies were eligible to compare different extents of thymic resection via median sternotomy, including 175 participants. 39,40 Figure 2 shows that the risk of achieving CSR at 3 years of follow-up was similar in patients who underwent extended transsternal compared to those who underwent basic transsternal thymectomy (RR 1.48, 95% CI 0.36–6.08, I 2 = 80%, p = 0.58; data available on Dryad, figures e-1–e-3, doi.org/10.5061/dryad.k98sf7m4w). Note, however, that the CIs for this analysis were quite wide given the low number.…”

Section: Resultsmentioning

confidence: 98%

“…A total of 1,598 patients with MG were enrolled in the 12 cohort studies and 1 randomized clinical trial included (figure 1). From the cohort studies, 7 involved 889 patients without thymoma, 39-44 4 studies involved 431 patients with or without thymoma, 12,45-47 and 1 study included 187 patients with thymoma. The 1 randomized study included only patients without thymoma.…”

Section: Resultsmentioning

confidence: 99%

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Impact of the Surgical Approach to Thymectomy Upon Complete Stable Remission Rates in Myasthenia Gravis

et al. 2021

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Objectives:To determine whether the available operative techniques for thymectomy in myasthenia gravis (MG) confer variable chances for achieving complete stable remission (CSR), we performed a meta-analysis of comparative studies of surgical approaches to thymectomy.Methods:Meta-analysis of all studies providing comparative data on thymectomy approaches, with CSR reported and minimum 3 years mean follow-up.Results:12 cohort studies and one randomized clinical trial, containing 1598 patients, met entry criteria. At 3 years, CSR from MG was similar following VATS extended vs. both basic (RR 1.00, p=1.00, 95% CI 0.39-2.58) and extended (RR 0.96, p=0.74, CI: 0.72-1.27) transsternal approaches. CSR at 3 years was also similar following extended transsternal vs. combined transcervical-subxiphoid (RR 1.08, p=0.62, CI: 0.8-1.44) approaches. VATS extended approaches remained statistically equivalent to extended transsternal approaches through 9 years of follow-up (RR 1.51, p=0.05, CI: 0.99-2.30). The only significant difference in CSR rate between a traditional open and a minimally invasive approach was seen at 10 years when comparing the now-abandoned basic (non-sternum-lifting) transcervical approach and the extended transsternal approach (RR 0.4, p=0.01, CI: 0.2-0.8).Conclusions:A significant difference in the rate of CSR among various surgical approaches for thymectomy in MG was identified only at long-term follow-up, and only between what might be considered the most aggressive approach (extended transsternal thymectomy) and the least aggressive approach (basic transcervical thymectomy). Extended minimally invasive approaches appear to have equivalent CSR rates to extended transsternal approaches and are therefore appropriate in the hands of experienced surgeons.

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Section: Resultsmentioning

confidence: 98%

Section: Resultsmentioning

confidence: 99%

Impact of the Surgical Approach to Thymectomy Upon Complete Stable Remission Rates in Myasthenia Gravis

et al. 2021

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“…Both TT for myasthenia gravis and TS for hyperhidrosis have been proved as effective treatments. [1389]…”

Section: Discussionmentioning

confidence: 99%

“…[2] In recent years, thoracoscopic thymectomy (TT) has been described as being able to achieve the same functional improvement as median sternotomy or the transcervical approach, but with less morbidity. [3]…”

Section: Introductionmentioning

confidence: 99%

Minimal access mediastinal surgery: One or two lung ventilation?

et al. 2009

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BACKGROUND:Minimal access mediastinal surgery (MAMS) is usually performed under general anaesthesia with double lumen tubes (DLT). The aim of this study is to evaluate two lung ventilation through single lumen tubes (SLT) during thoracoscopic sympathectomy for hyperhidrosis and thoracoscopic thymectomy for myasthenia gravis.METHODS:In this prospective non-randomized study, MAMS was performed in 58 patients with hyperhidrosis and 42 patients with myasthenia gravis, from January 2002 to December 2008. Patients were intubated with a DLT or SLT, 50 patients in each group. In the DLT group, endobronchial tubes were placed using the traditional blind approach and one lung ventilation was confirmed clinically. In the SLT group, the hemithorax was insufflated with CO2 in conjunction with two-lung anaesthesia. All the patients were evaluated for haemodynamic stability, oxygen saturation of haemoglobin (Spo2), end-tidal Pco2 (ETPco2), times required for intubation and surgery, satisfaction of surgeon with regard to exposure and postoperative complications.RESULTS:In the SLT group, all the patients had stable haemodynamic and ventilation parameters. In the DLT group, haemodynamic instability occurred in two, decrease in Spo2 in four and increase in ETPco2 in three patients. One patient in the DLT group developed vocal cord granuloma two months later. Time required for surgery and the surgeon's opinion with regard to exposure were similar for both groups.CONCLUSION:Thoracoscopic surgery when used in cases where a well-collapsed lung may not be essential, since surgery is not performed on the lung itself, does not require DLT. SLT is safe in MAMS. It provides good surgical exposure and decreases the cost, time and undesirable complications of DLT.

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“…Although total thymectomy is considered the goal of surgery, it has not been clearly shown that this is necessary, nor is it certain that all the surgical techniques are able to achieve this goal [4]. Although transsternal thymectomy has been the standard approach for many years, other options have been reported [5][6][7][8][9][10]. Nevertheless, the optimal surgical approach to thymectomy is still a matter of debate.…”

Section: Introductionmentioning

confidence: 97%

Transcervical video-assisted thymectomy: preliminary results of a modified surgical approach

Ampollini

Río

Sianesi

et al. 2010

Langenbecks Arch Surg

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Matched-pair comparison of three different approaches for thymectomy in myasthenia gravis

Abstract: There was adequate cumulative medium-term improvement of MG and less postoperative morbidity after tThx, which may become the preferred technique for Thx.

Cited by 34 publications

References 20 publications

Impact of the Surgical Approach to Thymectomy Upon Complete Stable Remission Rates in Myasthenia Gravis

Impact of the Surgical Approach to Thymectomy Upon Complete Stable Remission Rates in Myasthenia Gravis

Minimal access mediastinal surgery: One or two lung ventilation?

Transcervical video-assisted thymectomy: preliminary results of a modified surgical approach

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