Video-assisted thoracic surgery for thymoma: long-term follow-up results and prognostic factors—single-center experience of 150 cases

Li, Jianfeng; Hui, Bengang; Xiao, Li; Xiao, Rongxin; Jiang, Guanchao; Li, Jun; Wang, Jun

doi:10.21037/jtd.2017.12.34

Cited by 25 publications

(17 citation statements)

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“…Previous articles have reported that WHO classification, Masaoka stage, and R0 resection status may influence the recurrence and long‐term prognosis of thymomas . COX regression analysis in our study indicated that Masaoka stage III + IV, not‐R0 resection, and recurrence were independent risk prognostic factors, but older age seemed to be a protective factor for recurrence, which was similar to the study by Li . The role of postoperative radiotherapy for thymomas remains controversial .…”

Section: Discussionsupporting

confidence: 87%

Surgical effect and prognostic factors of myasthenia gravis with thymomas

et al. 2020

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Background: To evaluate the surgical effect and prognostic factors of extended thymectomy for myasthenia gravis (MG) patients with thymomas. Methods: Patients with MG with thymomas who underwent extended thymectomy at Peking University People's Hospital and Beijing Hospital between January 2010 and December 2018 were retrospectively enrolled. Patients were followed up by telephone or outpatient record review . Statistical analyses were performed using SPSS version 19.0. Results: A total of 194 patients were included in this study. According to the Osserman classification, there were 56 type I, 52 type IIa, 67 type IIb, 14 type III, and five type IV. Video-assisted thoracoscopic surgery (VATS) thymectomies were performed in 137 patients, and transthymectomies in 57 patients. The average operation time was 136.6 AE 46.5 minutes, average blood loss was 129.3 AE 287.4 mL, and average postoperative stay was 8.3 AE 7.4 days. A total of 170 patients (87.6%) were successfully followed up. The median follow-up period was 45 months, and the five-year overall survival (OS) rate was 81.9%. Cox regression analysis demonstrated that age, Masaoka stage, and recurrence were prognostic factors of OS. Tumor recurrence tended to occur in patients with Masaoka stage III + IV, and age was a protective factor. A total of 20 patients experienced postoperative myasthenic crisis (POMC). Univariate analysis indicated that presence of bulbar symptoms, surgical procedure, and blood loss were risk factors for POMC, but multivariate analysis only indicated the presence of bulbar symptoms as an independent risk factor. A total of 162 patients were evaluated for post intervention MG status. A total of 55 patients achieved complete stable remission; the overall effective rate was 84.5%. Older patients and those with B-type thymomas had a lower probability of achieving complete stable remission. Efficacy was similar in patients who underwent VATS or the transsternal procedure. Conclusions: Age, Masaoka stage, and recurrence were prognostic factors of OS. Presence of bulbar symptoms was an independent risk factor for POMC. Age and World Health Organization classification influence the postoperative effect of MG. Key pointsSignificant findings of the study Age, Masaoka stage, and recurrence were prognostic factors of OS for MG with thymomas. The presence of bulbar symptoms was an independent risk factor for POMC. Age and World Health Organization classification may influence the postoperative effect of MG. What this study addsOur study had a relatively large sample size of MG patients with thymomas only. We emphasize the analysis of the postoperative effect of MG and overall survival for these patients, which is a complement to previous studies. Transsternal thymectomyPatients were placed in the supine position with the shoulders upward under general anesthesia. A single-lumen tube was used for intubation. Through a complete sternotomy, the sternum was retracted using a retractor. After entering the mediastinum, the thymoma, whole thymus, and all a...

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Section: Discussionsupporting

confidence: 87%

Surgical effect and prognostic factors of myasthenia gravis with thymomas

et al. 2020

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“…In addition, this study included 1 case of suspected thymoma without a preoperative manifestation of myasthaenia gravis or signs of invasion in imaging. VATS appears to be feasible and safe for the resection of early-stage thymomas compared to median sternotomy [ 13 , 14 ]. Furthermore, VATS is reliable and safe for resection of large and invasive mediastinal tumours [ 15 ].…”

Section: Discussionmentioning

confidence: 99%

Simultaneous uniportal video-assisted thoracic surgery for pulmonary nodules and synchronous mediastinal lesions.

Zeng¹,

Zhuang²,

Tu³

2020

Videosurgery and Other Miniinvasive Techniques

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Introduction Video-assisted thoracic surgery (VATS) has been widely accepted in the diagnosis and treatment of thoracic diseases for the past three decades due to its small incision, minimal trauma, and rapid recovery after surgery. A growing number of patients with concurrent pulmonary nodules and mediastinal lesions have been detected. Simultaneous ipsilateral resection of coexisting lesions is a preferred procedure. Aim To introduce our technique and preliminary experience in performing uniportal video-assisted thoracic surgery (VATS) for the simultaneous resection of pulmonary and mediastinal lesions. Material and methods We retrospectively analysed 8 consecutive patients who underwent simultaneous uniportal VATS resection of coexisting lesions of the lung and mediastinum in our centre. The clinical data were recorded and analysed. Results A total of 8 patients were enrolled, and all patients successfully underwent surgery through a single incision; no perioperative deaths occurred. The average single incision length was 3.9 ±0.3 cm, the operative time was 102.3 ±54.4 min, and the bleeding volume was 27.5 ±17.9 ml. The thoracic drainage time was 3.0 ±2.3 days, with a mean volume of 390.6 ±361.3 ml. The length of postoperative hospital stay was 4.0 ±1.9 (range: 3–9) days. No serious complications were observed in the hospital or during postoperative follow-up. Conclusions Uniportal VATS is feasible and safe for the simultaneous resection of pulmonary and mediastinal lesions in selected patients and offers cosmetically pleasing incisions and promising clinical application prospects.

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“…Li et al reported that age and Masaoka-Koga stage were prognostic factors for thymomas. 4 Similarly, Mou et al concluded that age, Masaoka-Koga stage, and postoperative radiation were prognostic factors for thymomas; 5 however, Yanagiya et al demonstrated that age and histological type rather than Masaoka-Koga stage were meaningful prognostic factors. 6 To date, large-scale studies on the prognostic factors of thymomas have been limited and the reported associations have not been confirmed.…”

Section: Introductionmentioning

confidence: 99%

“…Several survival predictors for thymomas have been proposed. Li et al reported that age and Masaoka–Koga stage were prognostic factors for thymomas . Similarly, Mou et al concluded that age, Masaoka–Koga stage, and postoperative radiation were prognostic factors for thymomas; however, Yanagiya et al demonstrated that age and histological type rather than Masaoka–Koga stage were meaningful prognostic factors .…”

Section: Introductionmentioning

confidence: 99%

Nomogram to predict thymoma prognosis: A population‐based study of 1312 cases

et al. 2019

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Background A thymoma is a common cancer within the anterior mediastinum; however, the prognostic characteristics have not been established. The aim of this study was to identify the prognostic factors and develop a nomogram for the prognostic prediction of patients with thymoma based on data from the Surveillance, Epidemiology, and End Results (SEER) database. Methods Patients with thymomas diagnosed between 1983 and 2014 were selected. Overall survival (OS) was estimated using the Kaplan–Meier method with the log‐rank test. Univariate and multivariate Cox proportional hazards regression analyses were performed to identify the independent prognostic factors, from which a nomogram for thymomas was created. External validation of the nomogram was performed using data from our center. Results A total of 1312 patients with thymomas were enrolled. Age, tumor size, Masaoka–Koga stage, chemotherapy administered, and surgery type were independent prognostic factors for OS. A nomogram for OS was formulated based on the independent prognostic factors and validated using an internal bootstrap resampling approach, which showed that the nomogram exhibited a sufficient level of discrimination according to the C‐index in training (0.713, 95% confidence interval 0.685–0.741) and (0.746, 95% confidence interval 0.625–0.867) validation cohorts. Conclusion Several prognostic factors for thymomas were identified. The nomogram developed in this study accurately predicted the 5‐year and 10‐year OS rates of patients with thymomas based on individual characteristics. Risk stratification using the survival nomogram could optimize individual therapy and follow‐up.

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Video-assisted thoracic surgery for thymoma: long-term follow-up results and prognostic factors—single-center experience of 150 cases

Abstract: VATS was a safe and effective procedure for treatment of thymomas with satisfactory prognosis. MG with thymoma treated by VATS had comparable neurological outcome to that associated with the trans-sternal approach.

Cited by 25 publications

References 21 publications

Surgical effect and prognostic factors of myasthenia gravis with thymomas

Surgical effect and prognostic factors of myasthenia gravis with thymomas

Simultaneous uniportal video-assisted thoracic surgery for pulmonary nodules and synchronous mediastinal lesions.

Nomogram to predict thymoma prognosis: A population‐based study of 1312 cases

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