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Hajjar WM, Almasry NW, Alarifi AS, Alfahad FB, Alanazi KA, Alfaleh AF. Comparison of the Outcomes Between Bilateral Thoracoscopic Maximal Thymectomy Versus Trans-Sternal Maximal Thymectomy for Non-Thyomomatous Myasthenia Gravis Patients: A Local University Hospital Experience. Cureus 2020; 12:e12288. [PMID: 33391962 PMCID: PMC7772111 DOI: 10.7759/cureus.12288] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/25/2020] [Indexed: 11/05/2022] Open
Abstract
INTRODUCTION Myasthenia gravis (MG) is an autoimmune disease characterized by excessive and intense weakness of both respiratory and skeletal muscles. Management of MG involves both medical and surgical treatment. The surgical management includes resection of the thymus gland by many approaches, either bilateral thoracoscopic maximal thymectomy (BTT) or trans-sternal maximal thymectomy (TS). We hypothesized that bilateral thoracoscopic maximal thymectomy is as effective as trans-sternal maximal thymectomy to treat and control the disease. OBJECTIVE This study aimed to compare the two approaches (BTT and TS) and determine which is better in terms of outcomes. METHODOLOGY A retrospective cohort study was conducted among 50 myasthenia gravies patients; 30 patients underwent bilateral thoracoscopic maximal thymectomy (BTT) and 20 were operated by trans-sternal maximal thymectomy (TS). The study was conducted at King Khalid University Hospital (KKUH), Riyadh, Saudi Arabia, between 2007 and 2017. RESULT The mean age of the MG patients was 32.6 years, ranging from 14 to 75. Thirty-four (68%) patients were females, and 16 (32%) were males. The BTT showed less operation time (P<0.0001) and less intubation time (anesthesia time), which was statistically significant (P<0.0001). Hospital stay and ICU stay were both reported to be less in BTT (4.03 and 0.37, respectively) with p-values of 0.006 and 0.0001, respectively. There was no significant association between all categorical study variables and the MG patients' outcome (BTT/TS) in terms of mortality, morbidity, complete stable remission, pharmacological remission, and complications. CONCLUSION Bilateral thoracoscopic maximal thymectomy is as effective as trans-sternal maximal thymectomy to control and treat the disease.
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Khanh HQ, Van Khoi N, Vuong NL. Long-term outcome in mediastinal malignancies: video-assisted thoracoscopic versus open surgery. Indian J Thorac Cardiovasc Surg 2020; 37:44-52. [PMID: 33442207 DOI: 10.1007/s12055-020-01023-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2020] [Revised: 07/20/2020] [Accepted: 07/24/2020] [Indexed: 11/25/2022] Open
Abstract
Purpose There are not many studies comparing long-term oncological outcomes between video-assisted thoracoscopic surgery (VATS) and open surgery for mediastinal malignancies. This study aimed to compare perioperative and long-term outcomes of these two techniques in the treatment of mediastinal malignancies. Methods This is a retrospective study: patients with mediastinal malignancies underwent VATS or open surgery from 2010 to 2013 and were followed until 2019. The primary endpoints were long-term oncological outcomes, including tumor recurrence and mortality. Secondary endpoints were perioperative outcomes (operative duration, blood loss, pain, chest drainage duration, hospital length of stay, and complications). Results There were 36 patients in the VATS group and 49 patients in the open group. The median follow-up duration was 90 months. VATS significantly reduced operation time (84.6 versus 124.8 min), blood loss (59.8 versus 235.2 ml), postoperative pain score (4.9 versus 6.7), the duration of chest tube drainage (2.1 versus 3.1 days), and postoperative hospital stay (5.2 versus 8.0 days). The two groups were comparable regarding the recurrence rate (2.4 versus 2.1/100 person-years) and mortality rate (0.8 versus 0.9/100 person-years). Conclusion Compared with open surgery, VATS is less traumatic, reduces postoperative chest drainage, and shortens hospital stay with comparable long-term oncological outcomes. We advocate the VATS approach as a favored option for the resection of mediastinal malignancies.
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Affiliation(s)
- Huynh Quang Khanh
- Department of Thoracic Surgery, Cho Ray Hospital, Ho Chi Minh City, Vietnam
| | - Nguyen Van Khoi
- Department of Thoracic Surgery, Cho Ray Hospital, Ho Chi Minh City, Vietnam
- Department of Thoracic and Cardiovascular Surgery, Faculty of Medicine, University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City, Vietnam
| | - Nguyen Lam Vuong
- Department of Thoracic and Cardiovascular Surgery, Faculty of Medicine, University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City, Vietnam
- Department of Medical Statistics and Informatics, Faculty of Public Health, University of Medicine and Pharmacy at Ho Chi Minh City, 217 Hong Bang, Ward 11, District 5, Ho Chi Minh City, Vietnam
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Zhao J, Bhatnagar V, Ding L, Atay SM, David EA, McFadden PM, Stamnes S, Lechtholz-Zey E, Wightman SC, Detterbeck FC, Kim AW. A systematic review of paraneoplastic syndromes associated with thymoma: Treatment modalities, recurrence, and outcomes in resected cases. J Thorac Cardiovasc Surg 2019; 160:306-314.e14. [PMID: 31982129 DOI: 10.1016/j.jtcvs.2019.11.052] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2019] [Revised: 11/05/2019] [Accepted: 11/06/2019] [Indexed: 12/13/2022]
Abstract
OBJECTIVE Paraneoplastic syndromes associated with thymomas remain incompletely understood. The objective was to examine the association between surgically resected thymomas and paraneoplastic syndromes over the past half century. METHODS A primary PubMed/MEDLINE search was used to identify published articles describing paraneoplastic syndromes associated with thymomas from 1960 to 2019. A secondary search identified additional articles referenced in the articles found in the primary search. Kaplan-Meier and log-rank test were used for time-to-event data analyses. RESULTS From 407 articles describing 507 patients, 123 different paraneoplastic syndromes were associated with thymoma. The 5 most common paraneoplastic syndromes were myasthenia gravis, pure red cell aplasia, lichen planus, Good syndrome, and limbic encephalitis. Complete or partial resolution of paraneoplastic syndrome symptoms after surgery was noted in 76% of patients, of whom 21% had a relapse or new paraneoplastic syndrome onset after surgery. The most common adjunctive therapy associated with resolution of paraneoplastic syndrome was corticosteroids (30%). For all patients after surgery, thymoma recurrence was observed in 17% of cases, whereas recurrence of paraneoplastic syndrome was observed in 34% of cases, and both were observed in approximately 11% of cases. The 5- and 10-year overall survivals were 78% and 66%, respectively. Improved overall survival was associated with patients who had total resolution from paraneoplastic syndrome. CONCLUSIONS A comprehensive assessment of publications over the past half century suggests that a multimodal treatment approach that includes surgical resection of thymomas is able to achieve paraneoplastic syndrome resolution in a majority of patients. Onset of new paraneoplastic syndromes after surgery is associated with the recurrence of the first paraneoplastic syndrome, and resolution of paraneoplastic syndrome is associated with improved overall survival.
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Affiliation(s)
- Jasmine Zhao
- Keck School of Medicine, University of Southern California, Los Angeles, Calif
| | - Vikrant Bhatnagar
- Ohio University Heritage College of Osteopathic Medicine, Athens, Ohio
| | - Li Ding
- Division of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, Calif
| | - Scott M Atay
- Division of Thoracic Surgery, Keck School of Medicine, University of Southern California, Los Angeles, Calif
| | - Elizabeth A David
- Division of Thoracic Surgery, Keck School of Medicine, University of Southern California, Los Angeles, Calif
| | - P Michael McFadden
- Division of Thoracic Surgery, Keck School of Medicine, University of Southern California, Los Angeles, Calif
| | - Stephanie Stamnes
- Keck School of Medicine, University of Southern California, Los Angeles, Calif
| | | | - Sean C Wightman
- Division of Thoracic Surgery, Keck School of Medicine, University of Southern California, Los Angeles, Calif
| | | | - Anthony W Kim
- Division of Thoracic Surgery, Keck School of Medicine, University of Southern California, Los Angeles, Calif.
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Yeung C, Dawson J, Gilbert S. Uniportal video-assisted thoracoscopy approach to the management of non-pulmonary diseases of the chest. J Thorac Dis 2019; 11:S2062-S2068. [PMID: 31637039 DOI: 10.21037/jtd.2019.03.21] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
The use of uniportal video-assisted thoracoscopy (u-VATS) is becoming a commonly used surgical technique and can be an effective approach for the surgical treatment of many pulmonary and non-pulmonary conditions. This review article summarizes current medical evidence informing the practice of u-VATS for treating non-pulmonary conditions including hyperhidrosis, hemothorax, pleural effusion, and thymic disease.
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Affiliation(s)
- Ching Yeung
- The Ottawa Hospital Research Institute, University of Ottawa, The Ottawa Hospital - General Campus, Ottawa, ON, Canada.,Faculty of Medicine, Department of Surgery, University of Ottawa, The Ottawa Hospital - General Campus, Ottawa, ON, Canada
| | - Jennifer Dawson
- The Ottawa Hospital Research Institute, University of Ottawa, The Ottawa Hospital - General Campus, Ottawa, ON, Canada
| | - Sebastien Gilbert
- The Ottawa Hospital Research Institute, University of Ottawa, The Ottawa Hospital - General Campus, Ottawa, ON, Canada.,Faculty of Medicine, Department of Surgery, University of Ottawa, The Ottawa Hospital - General Campus, Ottawa, ON, Canada
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Nguyen GT, Nguyen TN, Nguyen NV, Nguyen KT, Le AV. Video-assisted thoracoscopic thymectomy for thymoma: a single-center experience. Asian Cardiovasc Thorac Ann 2018; 26:207-211. [PMID: 29411632 DOI: 10.1177/0218492318759348] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Background Thymoma is a primary tumor derived from the epithelial cells of the thymus, which is commonly seen in the mediastinum. Surgical thymectomy is the radical treatment for thymoma. The recent introduction of video-assisted thoracoscopic surgery has improved the quality of thymectomy surgery. The clinical characteristics of thymoma and the outcomes of video-assisted thoracoscopic thymectomy in Vietnamese patients are still lacking. The objectives of this study were to investigate the clinical and laboratory characteristics of thymoma and to evaluate the early results of video-assisted thoracoscopic thymectomy for thymoma in Vietnamese patients. Methods All 53 thymoma patients with or without myasthenia gravis who underwent video-assisted thoracoscopic thymectomy in Military Hospital 103, Vietnam, from October 2013 to July 2017 were included. Results The mean age was 46.5 7.1 years, and the female/male ratio was 1.2:1. Myasthenia gravis, mostly stage IIA, was present in 84.9% of patients. There was no hospital mortality or major postoperative complication. The mean operative time was 65 min, intensive care unit stay was 22 ± 5 h, and postoperative hospital stay was 7.5 ± 1.7 days. Conclusion Thoracoscopic thymectomy for thymoma in Vietnamese patients achieved improved cosmesis and was safe for both non-myasthenia gravis and myasthenia gravis patients.
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Affiliation(s)
- Giang Truong Nguyen
- 1 Department of Cardiothoracic Surgery, Military Hospital 103, Vietnam Military Medical University, Hanoi, Vietnam
| | - Trung Ngoc Nguyen
- 1 Department of Cardiothoracic Surgery, Military Hospital 103, Vietnam Military Medical University, Hanoi, Vietnam
| | - Nam Van Nguyen
- 1 Department of Cardiothoracic Surgery, Military Hospital 103, Vietnam Military Medical University, Hanoi, Vietnam
| | - Kien Trung Nguyen
- 2 Department of Anesthesiology, Military Hospital 103, Vietnam Military Medical University, Hanoi, Vietnam
| | - Anh Viet Le
- 1 Department of Cardiothoracic Surgery, Military Hospital 103, Vietnam Military Medical University, Hanoi, Vietnam
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Santini M, Fiorelli A. Surgery: Recommendations for Surgeons. CURRENT CLINICAL PATHOLOGY 2018:43-64. [DOI: 10.1007/978-3-319-90368-2_5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/02/2023]
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Caronia FP, Arrigo E, Trovato S, Lo Monte AI, Cottone S, Sgalambro F, Guglielmo M, Volpicelli A, Fiorelli A. Uniportal bilateral video-assisted sequential thoracoscopic extended thymectomy. J Vis Surg 2017; 3:69. [PMID: 29078632 DOI: 10.21037/jovs.2017.03.29] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2017] [Accepted: 03/21/2017] [Indexed: 11/06/2022]
Abstract
Standard video-assisted thoracoscopic surgery has been reported as a minimally invasive approach alternative to sternotomy for management of myasthenia gravis (MG) associated with thymoma or thymic hyperplasia. Uniportal video-thoracoscopy is an evolution of standard multi-portal video-thoracoscopy for management of several thoracic diseases but its role for resecting mediastinal tumor remains under-evaluated. Herein, we describe our experience with bilateral uniportal thoracoscopic sequential extended thymectomy with case and video illustrations.
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Affiliation(s)
| | - Ettore Arrigo
- Istituto Oncologico del Mediterraneo, Viagrande, Italy
| | | | | | - Salvatore Cottone
- Azienda Ospedaliera Ospedali Riuniti Villa Sofia-Cervello, Palermo, Italy
| | | | | | - Antonio Volpicelli
- Thoracic Surgery Unit, Seconda Università degli Studi di Napoli, Naples, Italy
| | - Alfonso Fiorelli
- Thoracic Surgery Unit, Seconda Università degli Studi di Napoli, Naples, Italy
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