Management of bleeding complications during thoracoscopic thymectomy

Minimally Invasive Thymectomy Could Be Attempted for Locally Advanced Thymic Malignancies: A Real-World Study With Propensity Score-Matched Analysis

INTRODUCTION

Increasing evidence supports minimally invasive thymectomy (MIT) for early stage thymic malignancies than open median sternotomy thymectomy (MST). Nevertheless, whether MIT could be attempted for locally advanced disease remains unclear.

METHODS

The clinical data of consecutive patients with stage T2-3NxM0 (eighth edition TNM staging) thymic malignancies who underwent MIT or MST were identified from a prospectively maintained database. The co-resected structures were rated with a resection index to evaluate surgical difficulty. The impact of surgical approach on treatment outcomes was investigated through propensity score-matched analysis and multivariable analysis.

RESULTS

From January 2008 to December 2019, a total of 128 patients were included; MIT was initially attempted in 58 (45.3%) cases, and eight (13.8%) were converted to MST during surgery. The conversion group had similar perioperative outcomes to the MST group, except for a longer operation time. After propensity score matching, the resection index scores were similar between the MIT and MST groups (3.5 versus 3.7, p = 0.773). The MIT group had considerably less blood loss (p < 0.001), fewer postoperative complications (p = 0.048), a shorter duration of chest drainage (p < 0.001), and a shorter hospitalization duration (p < 0.001) than the MST group. The 5-year freedom from recurrence rate was not different between the two groups (78.2% versus 78.5%, p = 0.942). In multivariable analysis, surgical approach was not associated with freedom from recurrence (p = 0.727).

CONCLUSIONS

MIT could be safely attempted in carefully selected patients with locally advanced thymic tumors. Conversion did not compromise the surgical outcomes. Patients may benefit from the less traumatic procedure and thus better recovery, with comparable long-term oncologic outcomes.

Improved activities of daily living in elderly patients with increased skeletal muscle mass during vertebral compression fracture rehabilitation

PURPOSE

We hypothesized that elderly patients with greater skeletal muscle mass have better activities of daily living (ADLs) than those with less skeletal muscle mass. The aim of this study was to evaluate the relationship between ADL improvement and changes in skeletal muscle mass among older patients ≥ 80 years of age who were undergoing rehabilitation for vertebral compression fracture (VCF).

METHODS

This case-control study was conducted at a rehabilitation hospital. The participants were 149 patients aged ≥ 80 years undergoing VCF rehabilitation. Patients were divided into two groups based on changes in their skeletal muscle mass index (SMI) during the hospitalization period: one group with increased SMI and the other without increased SMI. Between-group and multivariate analyses were performed to evaluate the factors associated with SMI increase.

RESULTS

The functional independence measure (FIM) gain was significantly higher in the group with SMI increase (36.0 [27.0-52.5], p = 0.016) than in the group without SMI increase (29.0 [19.0-41.0]). SMI gain was significantly associated with motor FIM gain (coefficient, 4.857; 95% confidence interval, 1.311-8.403; p = 0.008). Motor FIM and MMSE on admission, the necessity of assistance in ADL before the injury, and Charlson Comorbidity Index, were also significantly associated with motor FIM gain.

CONCLUSIONS

This study indicated that rehabilitation to gain skeletal muscle was effective in improving ADLs in elderly patients with VCF. We might encourage older patients with VCFs to undertake rehabilitation for the purpose of building skeletal muscle and improving their ADLs, and to not refrain from such rehabilitation due to old age and fractures.