The short and long-term effects of open vs minimally invasive thymectomy in myasthenia gravis patients: a systematic review and meta-analysis

OBJECTIVE

Thymectomy has been utilized as a treatment for Myasthenia Gravis (MG) for many decades, with both open and minimally invasive surgical (MIS) techniques currently used. Although MIS has shown improved short-term results, long-term effects remain uncertain. This systematic review and meta-analysis aim to compare the post-operative and long-term outcomes of MIS versus open thymectomy in MG patients.

METHODS

MEDLINE, EMBASE and CENTRAL databases were searched from inception till January 2022 for keywords related to MG and open or MIS thymectomy. Primary outcome was complete stable remission (CSR), and secondary outcomes were clinical improvement, complications, length of stay, operation time, and blood loss. Grading of recommendations, assessment, development, and evaluation was used to assess the certainty of evidence.

RESULTS

26 studies with 3588 patients were included in the analysis. At 1, 3 and 5 years, there was no statistical difference noted in CSR between open versus MIS thymectomy. However, CSR was improved at 1 year for MIS thymectomy in non-thymomatous MG (P = 0.03). There was no significant difference in rates of partial clinical improvement between techniques at 1-year. Although analyses on length of hospital stay and blood loss showed improvement following MIS thymectomy, operative time was shorter for open thymectomy.

CONCLUSION

This is the first systematic review and meta-analysis assessing long-term effects of MIS versus open thymectomy in MG patients. Given the lack of significant differences noted, either MIS or open thymectomy can be performed, based on surgeon preference. Further high-level, long-term research should be conducted to determine the benefit of each technique.

Sternotomy versus video-assisted thoracoscopic surgery for thymectomy of myasthenia gravis patients: A meta-analysis

INTRODUCTION

The purpose of this study was to compare thymectomy by video-assisted thoracoscopic surgery (VATS) and trans-sternal thymectomy (TS) for myasthenia gravis patients.

METHODS

A meta-analysis was conducted to compare thoracoscopic surgery and sternotomy for myasthenia gravis patients with regard to long-term effect and short-term safety.

RESULTS

A total of 23 trials were included in our research. No significant differences were detected with regard to myasthenic crisis, wound infection, and muscle weakness improvement. VATS led to less blood loss than TS (standardized mean difference, -1.233; 95% confidence interval, -1.425--1.041; P < 0.001), less risk of pulmonary infection (relative risk, 1.035; 95% confidence interval, 1.001-1.070; P = 0.043), and a shorter hospital stay. TS had a shorter operative time than VATS (standardized mean difference, 0.239; 95% confidence interval, 0.113-0.365; P < 0.001). VATS and TS achieved similar mean specimen weights and complete stable remission rates.

CONCLUSION

Based on the results of this meta-analysis of retrospective cohort studies, VATS increases surgical safety and achieves an equal surgical efficacy to TS, but TS has a shorter operative time.

Video-assisted thoracoscopic surgery thymectomy versus open thymectomy in patients with myasthenia gravis: a meta-analysis

BACKGROUND

Video-assisted thoracoscopic surgery (VATS) thymectomy has become a feasible treatment for myasthenia gravis (MG) in recent years. The objective of the present meta-analysis was to evaluate the perioperative characteristics, safety, and completely stable remission rate in patients with MG who received VATS or open thymectomy (OT).

METHODS

We searched PubMed, Embase, ScienceDirect, Web of Science, and CNKI for related articles using combinations of the search terms video-assisted thoracoscopic thymectomy, transsternal thymectomy, and MG. The inter-study heterogeneity was assessed by χ²-based Q statistics, and the extent of inconsistency was generated by I² statistics.

RESULTS

A total of 12 studies with 1173 patients were included, and there was no difference in the operation time (p = 0.08) and ICU time (p = 0.14) between the two groups, but VATS thymectomy was associated with less intra-operation blood loss and hospital time (p < 0.00001). VATS was also associated with lower rates of total complication (OR =0.59; 95% CI, 0.37-0.94; p = 0.03) and myasthenic crisis (OR = 0.51; 95% CI, 0.28-0.92; p = 0.03), but the rates of pneumonia (OR = 0.59; 95% CI, 0.29-1.32; p = 0.21) and complete remission rate (CSR) (OR = 0.64; 95% CI, 0.38-1.09; p = 0.10) had no obvious differences between the VATS and OT groups.

CONCLUSION

Patients with MG undergoing VATS thymectomy achieved better surgical outcomes and fewer complications than those who received OT.