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Li Z, Wang F, Zhang H, Zheng H, Zhou X, Wang Z, Xie S, Peng L, Wang X, Wang Y. The predictive value of a computed tomography-based radiomics model for the surgical separability of thymic epithelial tumors from the superior vena cava and the left innominate vein. Quant Imaging Med Surg 2023; 13:5622-5640. [PMID: 37711814 PMCID: PMC10498270 DOI: 10.21037/qims-22-1050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Accepted: 06/20/2023] [Indexed: 09/16/2023]
Abstract
Background The aim of this study was to develop a radiomics machine learning model based on computed tomography (CT) that can predict whether thymic epithelial tumors (TETs) can be separated from veins during surgery and to compare the accuracy of the radiomics model to that of radiologists. Methods Patients who underwent thymectomy at our hospital from 2009 to 2017 were included in the screening process. After the selection of patients according to the inclusion and exclusion criteria, the cohort was randomly divided into training and testing groups, and CT images of these patients were collected. Subsequently, two-dimensional (2D) and three-dimensional (3D) regions of interest were labelled using ITK-SNAP 3.8.0 software, and Radiomics features were extracted using Python software (Python Software Foundation) and selected through the least absolute shrinkage and selection operator (LASSO) regression model. To construct the classifier, a support vector machine (SVM) was employed, and a nomogram was created using logistic regression to predict vascular inseparable TETs based on the radiomics score (radscore) and image features. To assess the accuracy of these models, area under receiver operating characteristic (ROC) curves of these models were calculated, and differences among the models were identified using the Delong test. Results In this retrospective study, 204 patients with TETs were included, among whom 21 were diagnosed with surgical vascularly inseparable TETs. The area under ROC curve (AUC) of the 2D model, 3D model, 2D + 3D model, and radiologist diagnoses were 0.94, 0.92, 0.95, and 0.87 in the training cohort and 0.95, 0.92, 0.98, and 0.78 in testing cohort, respectively. The Delong test revealed a significant improvement in the performance of the radiomics models compared to radiologists' diagnoses. The logistic regression selected 3 image features, namely maximum diameter of the tumor, degree of abutment of vessel circumference >50%, and absence of the mediastinal fat layer or space between the tumor and surrounding structures. These features, along with the radscore, were included to develop a nomogram. The AUCs of this nomogram were 0.99 in both the training set and testing set, and the Delong test did not find a significant difference between ROC plots of the nomogram and radiomics models. Conclusions The proposed radiomics model could accurately predict surgical vascularly inseparable TETs preoperatively and was shown to have a higher predictive value than the radiologists.
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Affiliation(s)
- Zhiyang Li
- Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu, China
- West China School of Medicine, West China Hospital, Sichuan University, Chengdu, China
| | - Fuqiang Wang
- Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Hanlu Zhang
- Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Hong Zheng
- School of Automation Engineering, University of Electronic Science and Technology of China, Chengdu, China
| | - Xue Zhou
- School of Automation Engineering, University of Electronic Science and Technology of China, Chengdu, China
| | - Zhensong Wang
- School of Automation Engineering, University of Electronic Science and Technology of China, Chengdu, China
| | - Shenglong Xie
- Department of Thoracic Surgery, Sichuan Provincial People’s Hospital, University of Electronic Science and Technology of China, Chengdu, China
| | - Lei Peng
- Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Xuyang Wang
- Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu, China
- West China School of Medicine, West China Hospital, Sichuan University, Chengdu, China
| | - Yun Wang
- Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu, China
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Algahtani H, Shirah B, Alshehri A, Al Hassani AN, Binseddeq HH, Mukhtar RM, Saleh B, Taj JA. Clinical Presentation, Management, and Outcome in Patients With Myasthenia Gravis: A Retrospective Study From Two Tertiary Care Centers in Saudi Arabia. Cureus 2021; 13:e20765. [PMID: 35111450 PMCID: PMC8794400 DOI: 10.7759/cureus.20765] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/27/2021] [Indexed: 11/18/2022] Open
Abstract
Introduction: A limited number of research studies were published to delineate the clinical pattern of myasthenia gravis in Saudi Arabia. This paper is an attempt to describe some of the clinical aspects related to this disease in two large centers from two main cities in Saudi Arabia. Methods: A retrospective multi-center observational study of patients diagnosed with myasthenia gravis was conducted. The study setting was King Abdulaziz Medical City in Jeddah and Riyadh, Saudi Arabia. The study period was 12 years, starting from January 2007 to May 2019. Results: A total of 144 patients were included in this study (60 males and 84 females). The most common symptoms at diagnosis were ocular symptoms in 118 patients (81.9%), diplopia in 84 patients (58.3%), and/or blurred vision in 30 patients (20.8%). The majority had positive anti-acetylcholine receptor antibodies (72.2%). Pyridostigmine was the most prescribed medication for 136 patients (94.4%). Immunosuppressive medications were prescribed for 114 patients (79.2%). Around 40% of patients had exacerbations, and approximately 20% were admitted to the ICU. Thymectomy was performed for 97 patients (67.4%). Conclusion: The present study indicates that the clinical presentation and management of myasthenia gravis remained the same in the last few years despite the introduction of new modalities of diagnosis such as the anti-muscle-specific kinase (anti-MuSK) and other autoantibodies tests. Furthermore, we observed that the number of exacerbations and ICU admission were high, which may indicate inadequate therapy. We are stressing the need for establishing specialized neuromuscular clinics with neurologists trained in neurophysiology to improve the diagnostic accuracy and outcomes for patients with myasthenia gravis.
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Lv L, Li W, Men W, Liu Z, Jiang C. Comparing the safety and efficacy of thoracoscopic surgery and thoracotomy for thymoma: a systematic review and meta-analysis. Gland Surg 2021; 10:3378-3388. [PMID: 35070898 PMCID: PMC8749091 DOI: 10.21037/gs-21-786] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2021] [Accepted: 12/15/2021] [Indexed: 04/06/2024]
Abstract
BACKGROUND To systematically evaluate the efficacy of thoracoscopic surgery compared to traditional thoracotomy for thymic tumors. METHODS We performed a literature search on computer of the PubMed, Embase, Cochrane Library, Web of Science, China Biology Medicine (CBM), WanFang, and China national knowledge infrastructure (CNKI) databases from the date of establishment of the database to April 2021, and retrieved randomized controlled trials (RCTs) and cohort studies on thoracoscopic surgery and thoracotomy with conventional open thoracic surgery. After independent screening of the literature by two assessors, the relevant data was extracted and the risk of bias in the included studies was evaluated. RevMan 5.3 software was used to perform the analysis. RESULTS Five RCTs and eight cohort studies were ultimately included, with a total of 1,093 patients. The results of meta-analysis showed that compared with traditional thoracoscopic surgery, thoracoscopy had shorter surgery duration (OR =22.2, 95% CI: -31.92, -12.52, P<0.00001), ICU stay (OR =0.29, 95% CI: 0.20, 0.42, P<0.00001), and hospitalization time (OR =0.531, 95% CI: 0.41, 0.69, P<0.00001) times, as well as reduced chest tube drainage time (OR =0.49, 95% CI: 0.33, 0.73, P=0.0004), less intraoperative bleeding (OR =43.27, 95% CI: -50.94, -35.60, P<0.00001), and a lower incidence of postoperative complications (OR =0.19, 95% CI: 0.11, 0.34, P<0.00001). However, the tumor recurrence rate was not significantly different between the two procedures (OR =0.69, 95% CI: 0.32, 1.48, P=0.34). DISCUSSION The existing evidence suggests that thoracoscopic surgery has shorter surgery duration, ICU stay time, hospitalization time, reduced thoracic tube drainage, less intraoperative bleeding, and a lower incidence of postoperative complications compared with traditional thoracotomy surgery. However, due to the poor quality of the included research, more high-quality studies need to be conducted to verify the above conclusions.
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Affiliation(s)
- Ling Lv
- Department of Thoracic Surgery, The First Affiliated Hospital of China Medical University, Shenyang, China
| | - Wenya Li
- Department of Thoracic Surgery, The First Affiliated Hospital of China Medical University, Shenyang, China
| | - Wanfu Men
- Department of Thoracic Surgery, The First Affiliated Hospital of China Medical University, Shenyang, China
| | - Zhenghua Liu
- Department of Thoracic Surgery, The First Affiliated Hospital of China Medical University, Shenyang, China
| | - Chenggang Jiang
- Department of Surgical Oncology and General Surgery, Key Laboratory of Precision Diagnosis and Treatment of Gastrointestinal Tumors, Ministry of Education, The First Affiliated Hospital of China Medical University, Shenyang, China
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Gao J, Jin C, Ao YQ, Tang J, Ding JY, Dong JH, Jiang JH. Minimally invasive thymectomy for myasthenia gravis: a 7-year retrospective study. Gland Surg 2021; 10:3342-3350. [PMID: 35070894 PMCID: PMC8749093 DOI: 10.21037/gs-21-756] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2021] [Accepted: 12/15/2021] [Indexed: 08/31/2023]
Abstract
BACKGROUND Thymectomy has been identified as an effective strategy for patients with myasthenia gravis (MG) and thymic masses. However, the best surgical approach remains a matter of debate. The aim of the present study was to compare the surgical and neurological outcomes of video-assisted thoracoscopic thymectomy with a modified subxiphoid and bilateral approach in patients with MG and thymic masses. METHODS From August 2013 to April 2018, 68 patients who were diagnosed with MG and thymic masses and underwent video-assisted thoracoscopic thymectomy with a modified subxiphoid (44 patients) or bilateral (24 patients) approach were included in this retrospective study. The surgical and neurological results were analyzed with propensity score matching. RESULTS After propensity score matching, the modified subxiphoid approach in video-assisted thoracoscopic thymectomy resulted in an obviously shorter operative time (P=0.00), drainage duration (P=0.00), less intraoperative blood loss (P=0.00), and shorter postoperative hospital stay (P=0.01). In terms of neurological outcomes, no significant difference was observed in the improvement in MG, with 2-year complete stable remission rates of 21.1% and 26.3% (P=0.68) and 2-year pharmacological remission rates of 31.6% and 26.3% (P=0.60) for the bilateral and subxiphoid approaches, respectively. Additionally, the approaches resulted in similar effects on the magnitudes of decrease in the prednisolone and pyridostigmine doses after 2 years, with average pyridostigmine dose reductions of 72.2% and 71.1% (P=0.78) and average prednisolone reductions of 76.8% and 71.7% (P=0.96) for the bilateral and subxiphoid approaches, respectively. CONCLUSIONS The modified subxiphoid approach was found to be superior to the bilateral approach in video-assisted thoracic surgery thymectomy in terms of the surgical outcomes and yielded similar neurological outcomes. Therefore, the modified subxiphoid approach is recommended as an alternative to the bilateral approach in the treatment of patients with MG and thymic masses.
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Affiliation(s)
- Jian Gao
- Department of Thoracic Surgery, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Chun Jin
- Department of Thoracic Surgery, Zhongshan Hospital, Fudan University, Shanghai, China
- Department of Thoracic Surgery, Changhai hospital, Naval Military Medical University, Shanghai, China
| | - Yong-Qiang Ao
- Department of Thoracic Surgery, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Jie Tang
- Department of Anesthesiology, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Jian-Yong Ding
- Department of Thoracic Surgery, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Ji-Hong Dong
- Department of Neurology, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Jia-Hao Jiang
- Department of Thoracic Surgery, Zhongshan Hospital, Fudan University, Shanghai, China
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Daum P, Smelt J, Ibrahim I. Perioperative management of myasthenia gravis. BJA Educ 2021; 21:414-419. [PMID: 34707886 PMCID: PMC8520038 DOI: 10.1016/j.bjae.2021.07.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/01/2021] [Indexed: 11/19/2022] Open
Affiliation(s)
- P. Daum
- St George's University Hospitals NHS Foundation Trust, London, UK
| | - J. Smelt
- St George's University Hospitals NHS Foundation Trust, London, UK
| | - I.R. Ibrahim
- St George's University Hospitals NHS Foundation Trust, London, UK
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Gao L, Lu J, Shen Z, Chen H, Kang M. A novel method of subxiphoid video-assisted thoracic surgery for thymectomy. ANNALS OF TRANSLATIONAL MEDICINE 2021; 9:1339. [PMID: 34532476 PMCID: PMC8422105 DOI: 10.21037/atm-21-4070] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/25/2021] [Accepted: 08/20/2021] [Indexed: 11/06/2022]
Abstract
Background With advances in thoracoscopic surgical instruments and techniques, subxiphoid video-assisted thoracic surgery (S-VATS) has become the main approach for anterior mediastinal tumor resection under thoracoscopy. However, the drawbacks of S-VATS, including it being a relatively unfixed surgical procedure, make it complicated and difficult for unexperienced surgeons to master. Methods This study retrospectively reviewed and analyzed consecutive patients with anterior mediastinal tumor or myasthenia gravis (MG) who underwent S-VATS at the Fujian Medical University Union Hospital, China, between March 2015 and April 2019.Patients were divided into the conventional group and the “four-zone one-way” group. Intraoperative and postoperative variables were compared between the groups. Cumulative sum (CUSUM) analysis was applied to determine the operation time (OT)-learning curve of the S-VATS “four-zone one-way” method. Results A total of 82 patients were included in this analysis, of which, 40 patients underwent the conventional method of S-VATS and 42 patients underwent the “four-zone one-way” method. Patients in the “four-zone one-way” group had significantly shorter OT (138.50±29.43 and 118.00±28.18 minutes, respectively; P=0.002) and significantly less blood loss (36.00±20.16 and 23.92±14.96 mL, respectively; P=0.003) compared with patients in the conventional group. Our data indicated that there was no difference of the efficacy of MG treatment between the 2 groups. The difference in the preoperative and postoperative quantitative MG scoring system score (QMG-score) and the dose reduction of cholinesterase inhibitors was comparable between patients in the 2 groups. According to the CUSUM analysis curve, after a steady improvement over phase I (cases 1–12 for the traditional method and cases 1–5 for the “four-zone one-way” method), the surgical procedure could be mastered. Phase III occurred after case 26 in the traditional group and case 28 in the “four-zone one-way” group, and is characterized by rapid improvements. Conclusions Compared with the conventional method of S-VATS, the “four-zone one-way” method significantly decreased OT and estimated blood loss. These results demonstrated the feasibility and safety of the “four-zone one-way” method of S-VATS.
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Affiliation(s)
- Lei Gao
- Department of Thoracic Surgery, Fujian Medical University Union Hospital, Fuzhou, China.,Key Laboratory of Ministry of Education for Gastrointestinal Cancer, Fujian Medical University, Fuzhou, China
| | - Jieming Lu
- Department of Thoracic Surgery, Fujian Medical University Union Hospital, Fuzhou, China
| | - Zhimin Shen
- Department of Thoracic Surgery, Fujian Medical University Union Hospital, Fuzhou, China
| | - Hongbo Chen
- Department of Thoracic Surgery, Fujian Medical University Union Hospital, Fuzhou, China
| | - Mingqiang Kang
- Department of Thoracic Surgery, Fujian Medical University Union Hospital, Fuzhou, China.,Key Laboratory of Ministry of Education for Gastrointestinal Cancer, Fujian Medical University, Fuzhou, China.,Fujian Key Laboratory of Cardio-Thoracic Surgery, Fujian Medical University, Fuzhou, China
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Napolitano MA, Werba G, Desai SA, Sparks AD, Mortman KD. Presenting Symptomatology of Mediastinal Masses and Its Effect on Surgical Outcomes. Am Surg 2021; 88:212-218. [PMID: 33522269 DOI: 10.1177/0003134821989038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE Mediastinal masses are commonly encountered by the thoracic surgeon. Few studies have reported on the frequency and characteristics of symptoms at presentation. The primary objective of this study is to determine how often patients present with symptoms from a mediastinal mass. The secondary objective is to determine if the presence of symptoms has an effect on outcomes after surgery. METHODS A retrospective review of an institutional database was performed. All patients who underwent surgical resection of a mediastinal mass from 2013 to 2019 were included in the analysis. Medical records were reviewed for the presence or absence of symptoms preoperatively, and these cohorts were compared. Multivariable analysis was performed, adjusting for clinical variables to assess for differences between these cohorts. RESULTS 70 patients underwent surgery for a mediastinal mass. The average age was 49.2 years, and 46 patients (65.7%) presented with symptoms. There were no significant differences in demographics between the symptomatic and asymptomatic groups. The most common symptom was dyspnea in 18 patients (22%), followed by chest pain (15 patients, 19%) and dysphagia (8 patients, 10%). When comparing symptomatic and asymptomatic patients, symptomatic patients had a larger tumor size (5.8 cm vs 3.8 cm, P = .04) and a longer length of stay (2.0 days vs 1.2 days, P = .02). CONCLUSIONS The majority of patients with mediastinal masses present with symptoms, with the most common symptom being dyspnea. Symptomatic patients are more likely to have a larger tumor and tend to have a longer length of hospital stay postoperatively compared to asymptomatic patients.
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Affiliation(s)
- Michael A Napolitano
- Department of Surgery, Division of Thoracic Surgery, 43963The George Washington University Hospital, Washington, DC, USA
| | - Gregor Werba
- Department of Surgery, Division of Thoracic Surgery, 43963The George Washington University Hospital, Washington, DC, USA
| | - Sonia A Desai
- Department of Surgery, Division of Thoracic Surgery, 43963The George Washington University Hospital, Washington, DC, USA
| | - Andrew D Sparks
- Department of Surgery, Division of Thoracic Surgery, 43963The George Washington University Hospital, Washington, DC, USA
| | - Keith D Mortman
- Department of Surgery, Division of Thoracic Surgery, 43963The George Washington University Hospital, Washington, DC, USA
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Rusidanmu A, Feng M, Xu J, Wang L, He C, Hu J. Trans-sternotomy versus video-assisted thoracic surgery for early-stage thymoma patients: a meta-analysis. Gland Surg 2020; 9:342-351. [PMID: 32420258 PMCID: PMC7225494 DOI: 10.21037/gs.2020.03.10] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2019] [Accepted: 02/14/2020] [Indexed: 11/06/2022]
Abstract
BACKGROUND Over the years, video-assisted thoracic surgery (VATS) thymectomy has progressively replaced trans-sternotomy (TS) in early-stage thymoma (Masaoka stage I and stage II). This meta-analysis aimed to confirm the differences in the efficacies of VATS and TS approaches in early-stage thymoma patients. METHODS A thorough literature search of the following online databases was performed: PubMed, Cochrane Library, Web of Science, and EMBASE. Appropriate search terms, such as "thymoma or thymus neoplasms or Thymic Carcinoma" and "Video-Assisted Thoracic Surgeries or Video-Assisted Thoracoscopic", were used with MeSH search methods. Heterogeneity was assessed first with the Q-test and inconsistency index and sensitivity analysis and subgroup analysis were then used to find the source of heterogeneity. RESULTS We retrieved 1,228 articles, 11 articles were selected as the subjects of our research, and 1,222 patients were included in the research (666 VATS cases versus 556 TS cases). VATS caused less blood loss (P=0.02), and required shorter hospital stay (P<0.001), shorter duration of chest tube drainage (P=0.03) than TS. No obvious difference was found in operative time (P=0.14), postoperative recurrence (OR =0.81, 95% CI: 0.35-1.85, P=0.613), postoperative complications (OR =0.60, 95% CI: 0.31-1.16, P=0.129) and R0 resection (OR =0.35, 95% CI: 0.12-1.04, P=0.06), but the trend showed that more patients in the TS group achieved R0 resection. CONCLUSIONS For early-stage thymoma patients, VATS thymectomy seems to provide many advantages to be considered as a legitimate alternative to TS; however, when performing VATS, surgeons should pay special attention to ensure that R0 resection is achieved.
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Affiliation(s)
- Aizemaiti Rusidanmu
- Department of Thoracic Surgery, the First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310003, China
| | - Mingyang Feng
- Zhejiang university school of Medicine, Hangzhou 310029, China
| | - Jinming Xu
- Department of Thoracic Surgery, the First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310003, China
| | - Luming Wang
- Department of Thoracic Surgery, the First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310003, China
| | - Cheng He
- Department of Thoracic Surgery, the First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310003, China
| | - Jian Hu
- Department of Thoracic Surgery, the First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310003, China
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Leow OQY, Cheng C, Chao YK. Trans-subxiphoid robotic surgery for anterior mediastinal disease: an initial case series. J Thorac Dis 2020; 12:82-88. [PMID: 32190357 DOI: 10.21037/jtd.2019.07.38] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Background Video-assisted thoracoscopic trans-subxiphoid surgery is an ideal technique for removing anterior mediastinal lesions. The diffusion of this method, however, has been limited by the complexity of surgical maneuvers to be performed in the narrow retrosternal space. Robotic surgery holds promise to overcome the technical limitations of the thoracoscopic trans-subxiphoid approach. Here, we describe a case series of patients who had undergone trans-subxiphoid robotic surgery-with a special focus on short-term outcomes. Methods Between January 2018 and January 2019, a total of 20 patients underwent trans-subxiphoid robotic surgery for maximal thymectomy or removal of anterior mediastinal masses. A 3-cm longitudinal incision was performed below the xiphoid process, through which carbon dioxide was insufflated and a camera port was inserted. Subsequently, the lower sections of the mediastinal pleura were detached bilaterally-followed by the creation of two bilateral 1-cm skin incisions on the anterior axillary line in the sixth intercostal space for the insertion of robotic arms. Upon completion of port positioning, the surgical robot was docked. Results All robotic surgery procedures were successfully completed. Neither conversion to open surgery nor the creation of additional ports was required. The median operating time and console time were 118 min [interquartile range (IQR): 84-147 min] and 92.5 min (IQR: 78.5-133.5 min), respectively. Drainage tube positioning was not required in 11 (55%) patients. There were no operative deaths, and the median length of postoperative hospital stay was 2.5 days (IQR: 2-3 days). One patient had postoperative chylothorax and received conservative treatment. Conclusions The results of this case series provide initial support to the clinical feasibility, safety, and short-term positive outcomes of trans-subxiphoid robot-assisted surgery for anterior mediastinal disease.
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Affiliation(s)
| | - Chuan Cheng
- Division of Thoracic Surgery, Chang Gung Memorial Hospital-Linko, Chang Gung University, Taoyuan
| | - Yin-Kai Chao
- Division of Thoracic Surgery, Chang Gung Memorial Hospital-Linko, Chang Gung University, Taoyuan
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Wu H, Lin Q, Liu Y, Chen L, Peng L, Hu Y, Yin S, Xu Q. The safety of thymic vein sealing with ultrasonic energy in video-assisted thoracoscopic surgery thymectomy. J Thorac Dis 2019; 11:3421-3426. [PMID: 31559046 DOI: 10.21037/jtd.2019.08.11] [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: 11/06/2022]
Abstract
Background The key for conducting thymectomy by thoracoscope is the treatment of thymic veins, as they are the most common source of bleeding. The traditional treatment is to cut off the distal and proximal vessels after Ham-Lock clamping. Our team found that it is safe and reliable to use ultrasonic energy to cut off thymic veins in previous open operations. This study aimed to investigate the feasibility and safety of thymic vein sealing with ultrasonic energy in video-assisted thoracoscopic surgery (VATS) thymectomy. Methods A total of 169 patients with or without thymic tumors who underwent thymectomy by thoracoscope were enrolled in the study. Among them, group A, with 89 patients, underwent thoracoscopic thymic vein resection by Ham-Lock, and group B, with 80 patients, did so by ultrasonic energy. The groups were compared in terms of the characteristics of patients, tumors, and perioperative period. Results There were no significant differences in patients' characteristics between the two groups (P>0.05). There was no significant difference between the two groups in blood transfusion, operation time, drainage, and hospitalization (P>0.05). There were no deaths, secondary operation and post-operative blood transfusion, and no serious complications leading to prolonged hospitalization. One patient in group A was converted to thoracotomy due to left anonymous venous hemorrhage, and one patient in group B had thymic venous hemorrhage, but the hemorrhage was successfully stopped under thoracoscope. Conclusions In VATS thymectomy (with or without thymic tumors), there is no significant difference in the treatment of thymic veins between Ham-Lock clipping and ultrasonic energy in conversion to open surgery in regards to thymic venous hemorrhage, postoperative drainage, blood transfusion, operation time, drainage, and hospital stay. Use of ultrasonic energy is a safe and reliable method for thymic vein disconnection.
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Affiliation(s)
- Hao Wu
- Department of Cardio-thoracic Surgery, Jiangxi Provincial People's Hospital Affiliated to Nanchang University, Nanchang 330006, China
| | - Qing Lin
- Department of Cardio-thoracic Surgery, Jiangxi Provincial People's Hospital Affiliated to Nanchang University, Nanchang 330006, China
| | - Yangchuan Liu
- Department of Cardio-thoracic Surgery, Jiangxi Provincial People's Hospital Affiliated to Nanchang University, Nanchang 330006, China
| | - Liru Chen
- Department of Cardio-thoracic Surgery, Jiangxi Provincial People's Hospital Affiliated to Nanchang University, Nanchang 330006, China
| | - Lei Peng
- Department of Cardio-thoracic Surgery, Jiangxi Provincial People's Hospital Affiliated to Nanchang University, Nanchang 330006, China
| | - Yeji Hu
- Department of Cardio-thoracic Surgery, Jiangxi Provincial People's Hospital Affiliated to Nanchang University, Nanchang 330006, China
| | - Sui Yin
- Department of Cardio-thoracic Surgery, Jiangxi Provincial People's Hospital Affiliated to Nanchang University, Nanchang 330006, China
| | - Quan Xu
- Department of Cardio-thoracic Surgery, Jiangxi Provincial People's Hospital Affiliated to Nanchang University, Nanchang 330006, China
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11
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Abstract
Surgery for substernal goiters can be technically demanding. Extensive mediastinal extension brings the thyroid gland into close quarters with vital intrathoracic structures. Proper preoperative planning is required to determine the potential need for an extracervical approach. Assessing the risk of requiring an extracervical approach is typically based on findings from cross-sectional imaging of the neck and chest. This article addresses the important anatomical considerations when resecting a large substernal goiter and also reviews various extracervical approaches.
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Affiliation(s)
- Martin A Hanson
- Department of Surgery, Head and Neck Service, Memorial Sloan Kettering Cancer Center, 1275 York Ave, C-1064, New York, NY 10021, USA.
| | - Ashok R Shaha
- Department of Surgery, Head and Neck Service, Memorial Sloan Kettering Cancer Center, 1275 York Ave, C-1064, New York, NY 10021, USA.
| | - James X Wu
- Department of Surgery, Head and Neck Service, Memorial Sloan Kettering Cancer Center, 1275 York Ave, C-1064, New York, NY 10021, USA.
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Chiu CH, Chao YK, Liu YH. Subxiphoid approach for video-assisted thoracoscopic surgery: an update. J Thorac Dis 2018; 10:S1662-S1665. [PMID: 30034832 DOI: 10.21037/jtd.2018.04.01] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
The transthoracic video-assisted thoracoscopic surgery (VATS) is considered as standard operation for various thoracic diseases. With the development of single-incision VATS, the thoracic surgery becomes less traumatic. However, chronic chest wound pain still an issue despite the less invasive approach. Therefore, subxiphoid VATS was proposed to overcome this problem. In this article, we review current applications, pros and cons, and potential developments of VATS through subxiphoid approach.
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Affiliation(s)
- Chien-Hung Chiu
- Division of Thoracic Surgery, Chang Gung Memorial Hospital-Linko, Chang Gung University, Taoyuan
| | - Yin-Kai Chao
- Division of Thoracic Surgery, Chang Gung Memorial Hospital-Linko, Chang Gung University, Taoyuan
| | - Yun-Hen Liu
- Division of Thoracic Surgery, Chang Gung Memorial Hospital-Linko, Chang Gung University, Taoyuan
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13
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Frick AE, Van Veer H, Decaluwé H, Coosemans W, Van Raemdonck D. The resident's point of view in the learning curve of thymic MIS: why should I learn it? J Vis Surg 2018; 4:85. [PMID: 29780731 DOI: 10.21037/jovs.2018.04.15] [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: 03/16/2018] [Accepted: 04/17/2018] [Indexed: 11/06/2022]
Abstract
Minimally invasive surgery (MIS) in thoracic surgery became quite popular during the last years. The aim of introducing and performing more MIS is to reduce surgical trauma, pain and complications in patients. Training in MIS increases operative time and thus cost in theatre but thus improves with experience. For a resident, the cases should be well selected with experienced supervision in a suitable setting with supporting staff and optimal instruments. Understanding the anatomy of the lung, using simulators, and attending workshops makes the learning curve shorter.
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Affiliation(s)
- Anna E Frick
- Department of Thoracic Surgery, University Hospitals Leuven, Leuven, Belgium
| | - Hans Van Veer
- Department of Thoracic Surgery, University Hospitals Leuven, Leuven, Belgium
| | - Herbert Decaluwé
- Department of Thoracic Surgery, University Hospitals Leuven, Leuven, Belgium
| | - Willy Coosemans
- Department of Thoracic Surgery, University Hospitals Leuven, Leuven, Belgium
| | - Dirk Van Raemdonck
- Department of Thoracic Surgery, University Hospitals Leuven, Leuven, Belgium
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Comparative study of video-assisted thoracoscopic surgery versus open thymectomy for thymoma and myasthenia gravis. Wideochir Inne Tech Maloinwazyjne 2018; 13:376-382. [PMID: 30302151 PMCID: PMC6174162 DOI: 10.5114/wiitm.2018.75835] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2018] [Accepted: 03/04/2018] [Indexed: 11/17/2022] Open
Abstract
Introduction Thymectomy is the preferred standard treatment in younger non-thymoma patients with myasthenia gravis as well as in patients with early stage thymoma. Total thymectomy by median sternotomy has been the surgical approach since resection of the thymus with video-assisted thoracoscopic surgery (VATS). Aim To compare the clinical outcomes of VATS thymectomy with conventional open thymectomy for neoplastic and non-neoplastic thymic diseases. Material and methods Forty patients underwent thymectomy between October 2012 and January 2016. Fifteen patients were male and 25 patients were female. The mean age was 40.3 ±17.7 years. Seventeen (55%) patients underwent VATS thymectomy and 23 (45%) patients underwent an open procedure. We retrospectively reviewed the data of the patients and compared these two techniques. Results The mean tumor size was 5.17 ±3.2 cm in the thymoma group (VATS 2.5 ±2.4 cm vs. open access 4.7 ±3.7 cm). None of the patients experienced a myasthenic crisis. Conversion to thoracotomy was required in 1 patient in the VATS group due to bleeding from the right internal mammary artery; therefore, the conversion rate was 2.5% among all the patients. No mortality occurred in either group. No significant difference was found in the perioperative blood loss, operative time or pain visual analogue scale scores. On the other hand, regarding postoperative drainage, duration of chest tube drainage and length of hospital stay, VATS thymectomy yielded better results and the differences were significant. Conclusions Video-assisted thoracoscopic surgery thymectomy can be performed for both neoplastic and non-neoplastic thymic diseases with minimal morbidity and mortality.
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Shen J, Tie H, Xu A, Chen D, Ma D, Zhang B, Zhu C, Wu Q. Inter-relationship among myasthenia gravis, WHO histology, and Masaoka clinical stage and effect on surgical methods in patients with thymoma: a retrospective cohort study. J Thorac Dis 2018; 10:2981-2990. [PMID: 29997965 DOI: 10.21037/jtd.2018.05.30] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Background The aim of study is to analyze the inter-relationship among WHO histology, myasthenia gravis (MG) and Masaoka stage and to assess the feasibility of thoracoscopic surgery in thymoma patients. Methods Data from 142 consecutive thymoma patients from January 2009 to March 2016 were retrospectively reviewed in our institution. Histological classification and clinical staging were assessed by WHO histology criteria and Masaoka stage. We investigated the clinical characteristics, inter-relationship among WHO histology, MG and Masaoka stage, and compared the feasibility and safety of thoracoscopic thymectomy by comparison of open thymectomy. Results Among 142 patients, the incidence of MG was 29.6%. Compared with A and AB-type thymomas, a higher prevalence of advance clinical stage was in B1 to C-type thymomas (37/63 vs. 9/43, P<0.001), and there was an increased trend of Masaoka stage from A to C-type thymomas (P<0.001). The incidence of MG was significantly higher in AB, B1 and B2-type thymomas than other type thymomas (23/63 vs. 6/44, P=0.009) and in early Masaoka clinical stage than advanced Masaoka clinical stage (29/80 vs. 12/59, P=0.042). Thoracoscopic surgery could significantly decrease blood loss in patients with (104.06±137.36 vs. 350.91±560.79 mL, P=0.001) or without MG (91.90±77.70 vs. 266.32±292.60 mL, P=0.02), with comparable complications. Additionally, thoracoscopic surgery could achieve an equal effect on the remission of MG with open surgery (7/11 vs. 10/14, P=1.000), and Masaoka stage was significantly associated with the remission of MG after thymectomy. Conclusions Our study suggests that WHO histology, MG, and Masaoka stage interrelate with one another, and Masaoka stage is an important prognostic factor in remission of MG after thymectomy in thymoma patients. Thoracoscopic thymectomy could achieve an equal efficacy to open thymectomy and should be recommended as a routine surgery for patients with early Masaoka stage.
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Affiliation(s)
- Jianfei Shen
- Department of Thoracic Surgery, Taizhou Hospital of Zhejiang Province, Wenzhou Medical University, Linhai 317000, China
| | - Hongtao Tie
- Department of Cardiothoracic Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing 400042, China
| | - Anyi Xu
- Department of Emergency Medicine, Taizhou Hospital of Zhejiang Province, Wenzhou Medical University, Linhai 317000, China
| | - Dan Chen
- Department of Cardiothoracic Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing 400042, China
| | - Dehua Ma
- Department of Thoracic Surgery, Taizhou Hospital of Zhejiang Province, Wenzhou Medical University, Linhai 317000, China
| | - Bo Zhang
- Department of Thoracic Surgery, Taizhou Hospital of Zhejiang Province, Wenzhou Medical University, Linhai 317000, China
| | - Chengchu Zhu
- Department of Thoracic Surgery, Taizhou Hospital of Zhejiang Province, Wenzhou Medical University, Linhai 317000, China
| | - Qingchen Wu
- Department of Cardiothoracic Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing 400042, China
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Shiomi K, Kitamura E, Ono M, Kondo Y, Naito M, Mikubo M, Matsui Y, Nishiyama K, Suda T, Satoh Y. Feasible and promising modified trans-subxiphoid thoracoscopic extended thymectomy for patients with myasthenia gravis. J Thorac Dis 2018; 10:1747-1752. [PMID: 29707329 DOI: 10.21037/jtd.2018.01.168] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Background We have used a promising, minimally invasive thoracoscopic technique of extended thymectomy for patients with myasthenia gravis (MG). The aim of this study was to report our promising technique, a modified single-port trans-subxiphoid approach (MTXA) and to compare perioperative outcomes and effects on MG between our approach and sternotomy. Methods We retrospectively reviewed records of all patients undergoing extended thymectomy for MG and/or thymoma between January 1, 2010 and December 31, 2016. The patients were divided into the MTXA group and Sternotomy group. Results Of the 50 consecutive patients undergoing extended thymectomy for MG, finally, 13 patients undergoing our MTXA extended thymectomy technique were compared with 20 patients undergoing extended thymectomy via sternotomy. Intraoperative blood loss, postoperative length of stay, and C-reactive protein value on postoperative day 1 were significantly more favorable in the MTXA group than the Sternotomy group (P<0.0001, P=0.0040 and P=0.0073, respectively). Furthermore, no significant differences in the frequency of patients with improvement of their Quantitative Myasthenia Gravis score and/or MG-Activities of Daily Living scale, decrease in the serum level of acetylcholine receptor antibody, and dose reduction of oral prednisone were seen between the two groups. Conclusions Our approach to extended thymectomy might be more favorable than sternotomy in patients with MG.
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Affiliation(s)
- Kazu Shiomi
- Department of Thoracic Surgery, Kitasato University School of Medicine, Kanagawa, Japan
| | - Eiji Kitamura
- Department of Medicine (Neurology), Kitasato University School of Medicine, Kanagawa, Japan
| | - Mototsugu Ono
- Department of Thoracic Surgery, Kitasato University School of Medicine, Kanagawa, Japan
| | - Yasuto Kondo
- Department of Thoracic Surgery, Kitasato University School of Medicine, Kanagawa, Japan
| | - Masahito Naito
- Department of Thoracic Surgery, Kitasato University School of Medicine, Kanagawa, Japan
| | - Masashi Mikubo
- Department of Thoracic Surgery, Kitasato University School of Medicine, Kanagawa, Japan
| | - Yoshio Matsui
- Department of Thoracic Surgery, Kitasato University School of Medicine, Kanagawa, Japan
| | - Kazutoshi Nishiyama
- Department of Medicine (Neurology), Kitasato University School of Medicine, Kanagawa, Japan
| | - Takashi Suda
- Division of Thoracic and Cardiovascular Surgery, Fujita Health University School of Medicine, Toyoake, Japan
| | - Yukitoshi Satoh
- Department of Thoracic Surgery, Kitasato University School of Medicine, Kanagawa, Japan
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Karunanantham J, Fok M, Ali JM, Peryt A, Coonar A, Aresu G. Subxiphoid single incision thoracoscopic surgery approach for thymectomy: a case report. J Vis Surg 2018; 3:147. [PMID: 29302423 DOI: 10.21037/jovs.2017.10.03] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2017] [Accepted: 10/10/2017] [Indexed: 11/06/2022]
Abstract
Thoracic surgery is rapidly evolving with minimally invasive strategies now dominating. Thymectomy has traditionally been performed through a sternotomy, but more recently video-assisted thoracoscopic surgery (VATS) approaches have become increasingly popular. To further minimise surgical impact, the uniportal subxiphoid VATS technique has recently been described, using a muscle sparing incision that avoids intercostal nerve injury. A potential advantage that makes this approach particularly suited to thymectomy includes the ability to access both sides of the chest with a single incision. There is also the potential for reduced post-operative pain and chronic thoracostomy neuralgia. Here we describe the management of a patient with thymoma, reporting our procedure and technique for performing uniportal subxiphoid VATS thymectomy.
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Affiliation(s)
- Jay Karunanantham
- Department of Thoracic Surgery, Papworth Hospital NHS Foundation Trust, Cambridge, UK
| | - Matthew Fok
- Department of Thoracic Surgery, Papworth Hospital NHS Foundation Trust, Cambridge, UK
| | - Jason M Ali
- Department of Thoracic Surgery, Papworth Hospital NHS Foundation Trust, Cambridge, UK
| | - Adam Peryt
- Department of Thoracic Surgery, Papworth Hospital NHS Foundation Trust, Cambridge, UK
| | - Aman Coonar
- Department of Thoracic Surgery, Papworth Hospital NHS Foundation Trust, Cambridge, UK
| | - Giuseppe Aresu
- Department of Thoracic Surgery, Papworth Hospital NHS Foundation Trust, Cambridge, UK
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18
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Kurganov IA, Panchenkov DN, Bogdanov DY, Emelianov SI, Ivanov YV, Khabarov YA, Urazovskyi NY. Comparative analysis of thymectomies through videothoracoscopic and transsternal approaches. ACTA ACUST UNITED AC 2018. [DOI: 10.17116/endoskop201824221] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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19
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Weaver H, Ali JM, Jiang L, Yang C, Wu L, Jiang G, Aresu G. Uniportal subxiphoid video-assisted thoracoscopic approach for thymectomy: a case series. J Vis Surg 2017; 3:169. [PMID: 29302445 DOI: 10.21037/jovs.2017.10.16] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2017] [Accepted: 10/26/2017] [Indexed: 12/21/2022]
Abstract
Background Minimally invasive techniques are becoming increasingly popular in thoracic surgery. Although median sternotomy is the traditional approach for thymectomy, video-assisted thoracoscopic surgery (VATS) approaches now predominate. This study reports a case series of the novel uniportal subxiphoid-VATS approach to extended thymectomy. Methods Over the period of study (October 2014-January 2017) 17 patients underwent uniportal subxiphoid-VATS extended thymectomy for a thymic nodule at the Shanghai Pulmonary Centre. Ten patients were female, and the mean age of the cohort was 55 years. The mean size of nodule was 23.6 mm. Results The mean operative duration was 2.5 hours, with one conversion to thoracotomy for bleeding. The mean operative blood loss was 115 mL. The median length of hospital stay was 4 days. There were no episodes of phrenic nerve palsies. The 30-day survival was 100%. Conclusions Uniportal subxiphoid-VATS is a feasible and safe surgical approach to extended thymectomy in selected patients, with good post-operative outcomes.
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Affiliation(s)
- Helen Weaver
- Department of Thoracic Surgery, Papworth Hospital NHS Foundation Trust, Papworth Everard, Cambridge, UK
| | - Jason M Ali
- Department of Thoracic Surgery, Papworth Hospital NHS Foundation Trust, Papworth Everard, Cambridge, UK
| | - Lei Jiang
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University, Shanghai 200433, China
| | - Chenlu Yang
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University, Shanghai 200433, China
| | - Liang Wu
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University, Shanghai 200433, China
| | - Gening Jiang
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University, Shanghai 200433, China
| | - Giuseppe Aresu
- Department of Thoracic Surgery, Papworth Hospital NHS Foundation Trust, Papworth Everard, Cambridge, UK
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Liu XD, Shao MR, Sun L, Zhang L, Jia XS, Li WY. Influence of body mass index on postoperative complications after thymectomy in myasthenia gravis patients. Oncotarget 2017; 8:94944-94950. [PMID: 29212280 PMCID: PMC5706926 DOI: 10.18632/oncotarget.19189] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2017] [Accepted: 06/10/2017] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVES It is not clear whether being overweight or obese influences postoperative complications in myasthenia gravis (MG) patients. We retrospectively investigated an association between body mass index (BMI) and postoperative complications in MG. MATERIALS AND METHODS Fifty-nine MG patients who had undergone transsternal thymectomy were classified as low or high BMI based on the criteria for Asian-Pacific populations. An association between BMI and complications was analyzed. RESULTS MG patients with high BMI had significantly higher rates of major adverse complications (P = 0.033), postoperative respiratory failure (P = 0.045), and longer postoperative hospitalization (P = 0.005). The optimal cutoff value of BMI for postoperative respiratory failure was 23.3 kg/m2, with a sensitivity of 75.0% and a specificity of 64.7% (P = 0.046). CONCLUSIONS MG patients with a BMI indicating overweight or obesity have a higher risk of postoperative complications after thymectomy. Thus, close monitoring must be performed when surgery is necessary.
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Affiliation(s)
- Xu-Dong Liu
- Department of Thoracic Surgery, The First Affiliated Hospital of China Medical University, Shenyang, Liaoning Province, China
- Department of Rheumatology and Immunology, The First Affiliated Hospital of China Medical University, Shenyang, Liaoning Province, China
| | - Ming-Rui Shao
- Department of Thoracic Surgery, The First Affiliated Hospital of China Medical University, Shenyang, Liaoning Province, China
| | - Lei Sun
- Department of Thoracic Surgery, The First Affiliated Hospital of China Medical University, Shenyang, Liaoning Province, China
| | - Lin Zhang
- Department of Thoracic Surgery, The First Affiliated Hospital of China Medical University, Shenyang, Liaoning Province, China
| | - Xin-Shan Jia
- Department of Pathology, The First Affiliated Hospital of China Medical University, Shenyang, Liaoning Province, China
- Department of Pathology, College of Basic Medical Sciences, China Medical University, Shenyang, Liaoning Province, China
| | - Wen-Ya Li
- Department of Thoracic Surgery, The First Affiliated Hospital of China Medical University, Shenyang, Liaoning Province, China
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Di Crescenzo VG, Napolitano F, Panico C, Di Crescenzo RM, Zeppa P, Vatrella A, Laperuta P. Surgical approach in thymectomy: Our experience and review of the literature. Int J Surg Case Rep 2017; 39:19-24. [PMID: 28787670 PMCID: PMC5545819 DOI: 10.1016/j.ijscr.2017.07.028] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2017] [Revised: 07/18/2017] [Accepted: 07/18/2017] [Indexed: 11/30/2022] Open
Abstract
Aim Thymectomy is the main treatment for thymoma and patients with myasthenia gravis (MG). The traditional approach is through a median sternotomy, but, recently, thymectomy through minimally invasive approaches is increasingly performed. Our purpose is an analysis and discussion of the clinical presentation, the diagnostic procedures and the surgical technique. We also consider post-operative complications and results, over a period of 5 years (May 2011–June 2016), in thymic masses admitted in our Thoracic Surgery Unit. Methods We analyzed 8 patients who underwent surgical treatment for thymic masses over a period of 5 years. 6 patients (75%) had thymoma, 2 patients (25%) had thymic carcinomas. 2 patients with thymoma (33%) had myasthenia gravis. We performed a complete surgical resection with median sternotomy as standard approach. Results One patient (12%) died in the postoperative period. The histological study revealed 6 (75%) thymoma and 2 (25%) thymic carcinomas. Post-operative morbidity occurred in 2 patients (25%) and were: pneumonia in 1 case (12%), atrial fibrillation and pleural effusion in 2 patients (25%). One patient with thymoma type A recurred at skeletal muscle 2-years after surgery. Conclusions Thymic malignancies are rare tumors. Surgical resection is the main treatment, but a multimodal approach is useful for many patients. Radical thymectomy is completed removing all the soft tissue in the anterior mediastinum between the two phrenic nerves and this is the most important factor in controlling myasthenia and influencing survival in patients with thymoma. Open (median sternotomy) approach has been the standard approach for thymectomy for the better visualization of the anatomical structures. Actually, video-assisted thoracoscopic surgery (VATS) thymectomy and robotic video-assisted thoracoscopic (R-VATS) approach versus open surgery has an equal if not superior oncological efficacy, better perioperative complications and survival outcomes.
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Affiliation(s)
| | - Filomena Napolitano
- Department of Medicine and Surgery, Thoracic Surgery Unit, University of Salerno, Italy.
| | - Claudio Panico
- Department of Medicine and Surgery, Thoracic Surgery Unit, University of Salerno, Italy.
| | - Rosa Maria Di Crescenzo
- Department of Medicine and Surgery, Pathology Unit, Federico II University of Naples, Italy.
| | - Pio Zeppa
- Department of Medicine and Surgery, Pathology Unit, University of Salerno, Italy.
| | - Alessandro Vatrella
- Department of Medicine and Surgery, Section of Respiratory Diseases, University of Salerno, Salerno, Italy.
| | - Paolo Laperuta
- Department of Medicine and Surgery, Thoracic Surgery Unit, University of Salerno, Italy.
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Odaka M, Tsukamoto Y, Shibasaki T, Mori S, Asano H, Yamashita M, Morikawa T. Surgical and oncological outcomes of thoracoscopic thymectomy for thymoma. J Vis Surg 2017; 3:54. [PMID: 29078617 DOI: 10.21037/jovs.2017.03.18] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2017] [Accepted: 01/16/2017] [Indexed: 11/06/2022]
Abstract
Thymoma remains the most common primary anterior mediastinal neoplasm. Surgical resection remains central to the treatment of thymoma, with thoracoscopic thymectomy (TT) being increasingly performed. This present review article aimed to summarize current studies comparing TT and open thymectomy (OT). Recently, most patients with Masaoka stage I-II thymoma have been receiving TT. This procedure is associated with a significantly shorter post-operative hospital stay, decreased intraoperative blood loss, and fewer complications compared with OT. Recurrence rates of thymoma after TT range from 0% to 6.7%, and the 5-year disease-free survival (DFS) ranges from 83.3% to 96%. The oncological outcomes of TT are comparable to that of OT. Masaoka stage and the World Health Organization (WHO) type classification are valuable predictors of the prognosis of thymoma; hence, the optimal treatment for thymoma should be performed according to these two. TT is less invasive, with equivalent oncological outcomes, when compared with the OT. Minimally invasive surgery including TT for stage I-II thymomas is becoming the mainstay of therapy.
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Affiliation(s)
- Makoto Odaka
- Department of Surgery, Jikei University School of Medicine, Minatoku, Tokyo 105-0003, Japan
| | - You Tsukamoto
- Department of Surgery, Jikei University School of Medicine, Minatoku, Tokyo 105-0003, Japan
| | - Takamasa Shibasaki
- Department of Surgery, Jikei University School of Medicine, Minatoku, Tokyo 105-0003, Japan
| | - Shohei Mori
- Department of Surgery, Jikei University School of Medicine, Minatoku, Tokyo 105-0003, Japan
| | - Hisatoshi Asano
- Department of Surgery, Jikei University School of Medicine, Minatoku, Tokyo 105-0003, Japan
| | - Makoto Yamashita
- Department of Surgery, Jikei University School of Medicine, Minatoku, Tokyo 105-0003, Japan
| | - Toshiaki Morikawa
- Department of Surgery, Jikei University School of Medicine, Minatoku, Tokyo 105-0003, Japan
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The Effect of Diagnostic Imaging on Surgical Treatment Planning in Diseases of the Thymus. CONTRAST MEDIA & MOLECULAR IMAGING 2017; 2017:9307292. [PMID: 29097942 PMCID: PMC5612708 DOI: 10.1155/2017/9307292] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/29/2016] [Revised: 10/05/2016] [Accepted: 11/15/2016] [Indexed: 11/17/2022]
Abstract
Accurate imaging of the thymus is essential in the diagnosis and surgical treatment of both neoplastic and nonneoplastic conditions. Imaging of the thymus is a rather complex task, which affects both initial diagnosis and further surgical treatment planning. Imaging techniques include a wide armamentary of possibilities, from the most frequently used computed tomography (CT) to 18-fluorodeoxyglucose positron emission tomography- (18-FDG-PET-) CT and chemical shift magnetic resonance imaging (CS-MRI). In cases where surgical treatment is involved diagnostic imaging is of pivotal importance, not only in distinguishing benign from malignant disease but also in making a way among subtypes of thymic conditions. The article presents a current review of the advantages and backdrops of different imaging techniques used in the diagnosis of benign and malignant thymic conditions, with emphasis on differential imaging of thymic hyperplasia (TH), ectopic thymic tissue (ETT), and thymic epithelial tumors (TETs), with special attention to the importance of MR imaging according to the new TNM classification of thymic epithelial tumors.
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