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Heng Zhao - One of the best experts on this subject based on the ideXlab platform.

  • surgical techniques for early stage thymoma video assisted thoracoscopic Thymectomy versus transsternal Thymectomy
    The Journal of Thoracic and Cardiovascular Surgery, 2014
    Co-Authors: Jicheng Tantai, Jian Feng, Ming Cheng, Jianxing Shi, Heng Zhao
    Abstract:

    Objective The present study compared the outcomes between patients who had undergone video-assisted thoracoscopic surgery (VATS) Thymectomy and transsternal (TS) Thymectomy for Masaoka stage I and II thymoma. Methods The outcomes of 262 patients without myasthenia gravis who had undergone surgery for Masaoka stage I and II thymoma from January 2008 to December 2012 at our center were retrospectively evaluated. The study included 125 patients who had undergone unilateral VATS Thymectomy (VATS group) and 137 patients who had undergone TS Thymectomy (TS group). Results The VATS group had a shorter operative time than the TS group (170 vs 210 minutes, P P P P P Conclusions Unilateral VATS Thymectomy for Masaoka stage I and II thymoma is technically feasible and safe and is less invasive than TS Thymectomy, with a shorter duration of surgery, less intraoperative blood loss, less postoperative pleural drainage, shorter postoperative pleural drainage duration, and shorter postoperative hospital stay. We have concluded that it is preferable to perform VATS Thymectomy, although perhaps under certain circumstances sternotomy might be preferred. The oncologic outcomes were comparable between the 2 procedures. Additional follow-up is required to evaluate the long-term outcomes.

  • surgical techniques for early stage thymoma video assisted thoracoscopic Thymectomy versus transsternal Thymectomy
    The Journal of Thoracic and Cardiovascular Surgery, 2014
    Co-Authors: Bo Ye, Jicheng Tantai, Jian Feng, Ming Cheng, Xiaoxiao Ge, Wang Li, Heng Zhao
    Abstract:

    OBJECTIVE: The present study compared the outcomes between patients who had undergone video-assisted thoracoscopic surgery (VATS) Thymectomy and transsternal (TS) Thymectomy for Masaoka stage I and II thymoma. METHODS: The outcomes of 262 patients without myasthenia gravis who had undergone surgery for Masaoka stage I and II thymoma from January 2008 to December 2012 at our center were retrospectively evaluated. The study included 125 patients who had undergone unilateral VATS Thymectomy (VATS group) and 137 patients who had undergone TS Thymectomy (TS group). RESULTS: The VATS group had a shorter operative time than the TS group (170 vs 210 minutes, P < .001). The VATS group also had a smaller intraoperative blood loss (200 vs 450 mL, P < .001), smaller pleural drainage volume in the first 24 hours postoperatively (300 vs 500 mL, P < .0010), shorter postoperative pleural drainage duration (3 vs 5 days, P < .001), and shorter postoperative hospital stay (8 vs 10 days, P < .001). Four patients in the VATS group underwent conversion to open surgery because of injury to the innominate vein. The postoperative complication rate was similar between the 2 groups. One patient in the VATS group developed pleural recurrence, and one in the TS group developed local recurrence. CONCLUSIONS: Unilateral VATS Thymectomy for Masaoka stage I and II thymoma is technically feasible and safe and is less invasive than TS Thymectomy, with a shorter duration of surgery, less intraoperative blood loss, less postoperative pleural drainage, shorter postoperative pleural drainage duration, and shorter postoperative hospital stay. We have concluded that it is preferable to perform VATS Thymectomy, although perhaps under certain circumstances sternotomy might be preferred. The oncologic outcomes were comparable between the 2 procedures. Additional follow-up is required to evaluate the long-term outcomes.

  • surgical treatment of early stage thymomas robot assisted thoracoscopic surgery versus transsternal Thymectomy
    Surgical Endoscopy and Other Interventional Techniques, 2014
    Co-Authors: Jian Feng, Jicheng Tantai, Ming Cheng, Heng Zhao
    Abstract:

    Background This study aimed to compare the perioperative outcomes for patients who underwent transsternal or robot-assisted Thymectomy and to determine the feasibility of robot-assisted Thymectomy for the treatment of Masaoka stages 1 and 2 thymomas.

Joseph B Shrager - One of the best experts on this subject based on the ideXlab platform.

  • impact of the surgical approach to Thymectomy upon complete stable remission rates in myasthenia gravis a meta analysis
    Neurology, 2021
    Co-Authors: Joseph B Shrager, Paola Solispazmino, Ioana Baiu, Eddy Lincangonaranjo, Winston Trope, Larry J Prokop, Oscar J Ponce
    Abstract:

    Objectives To determine whether the available operative techniques for Thymectomy in myasthenia gravis (MG) confer variable chances for achieving complete stable remission (CSR), we performed a meta-analysis of comparative studies of surgical approaches to Thymectomy. Methods Meta-analysis was done of all studies providing comparative data on Thymectomy approaches, with CSR reported and minimum 3-year mean follow-up. Results Twelve cohort studies and 1 randomized clinical trial, containing 1,598 patients, met entry criteria. At 3 years, CSR from MG was similar after video-assisted thoracoscopic (VATS) extended vs both basic (relative risk [RR] 1.00, p = 1.00, 95% confidence interval [CI] 0.39–2.58) and extended (RR 0.96, p = 0.74, 95% CI 0.72–1.27) transsternal approaches. CSR at 3 years was also similar after extended transsternal vs combined transcervical-subxiphoid (RR 1.08, p = 0.62, 95% CI 0.8–1.44) approaches. VATS extended approaches remained statistically equivalent to extended transsternal approaches through 9 years of follow-up (RR 1.51, p = 0.05, 95% CI 0.99–2.30). The only significant difference in CSR rate between a traditional open and a minimally invasive approach was seen at 10 years when the now-abandoned basic (non–sternum-lifting) transcervical approach was compared to the extended transsternal approach (RR 0.4, p = 0.01, 95% CI 0.2–0.8). Conclusions A significant difference in the rate of CSR among various surgical approaches for Thymectomy in MG was identified only at long-term follow-up and only between what might be considered the most aggressive approach (extended transsternal Thymectomy) and the least aggressive approach (basic transcervical Thymectomy). Extended minimally invasive approaches appear to have CSR rates equivalent to those of extended transsternal approaches and are therefore appropriate in the hands of experienced surgeons.

  • a national analysis of open versus minimally invasive Thymectomy for stage i to iii thymoma
    The Journal of Thoracic and Cardiovascular Surgery, 2020
    Co-Authors: Chifu Jeffrey Yang, Joseph B Shrager, Leah M Backhus, Jacob Hurd, Shivani A Shah, Douglas Z Liou, Hanghang Wang, Thomas A Damico, Mark F Berry
    Abstract:

    Abstract Objective The oncologic efficacy of minimally invasive Thymectomy for thymoma is not well characterized. We compared short-term outcomes and overall survival between open and minimally invasive (video-assisted thoracoscopic and robotic) approaches using the National Cancer Data Base. Methods Perioperative outcomes and survival of patients who underwent open versus minimally invasive Thymectomy for clinical stage I to III thymoma from 2010 to 2014 in the National Cancer Data Base were evaluated using multivariable Cox proportional hazards modeling and propensity score–matched analysis. Predictors of minimally invasive use were evaluated using multivariable logistic regression. Outcomes of surgical approach were evaluated using an intent-to-treat analysis. Results Of the 1223 thymectomies that were evaluated, 317 (26%) were performed minimally invasively (141 video-assisted thoracoscopic and 176 robotic). The minimally invasive group had a shorter median length of stay when compared with the open group (3 [2-4] days vs 4 [3-6] days, P  Conclusions In this national analysis, minimally invasive Thymectomy was associated with shorter length of stay and was not associated with increased margin positivity, perioperative mortality, 30-day readmission rate, or reduced overall survival when compared with open Thymectomy.

  • non myasthenia gravis immune syndromes and the thymus is there a role for Thymectomy
    Thoracic Surgery Clinics, 2019
    Co-Authors: Sean C Wightman, Joseph B Shrager
    Abstract:

    Thymectomy has long been considered, performed, and discussed for many different nonmyasthenic immune syndromes. Thymectomy is now an established treatment for MG, and has been performed for other immune syndromes with varying degrees of improvement. Although numerous reports document immune syndromes' association with thymoma, few address the role of Thymectomy in symptom resolution. This review assesses Thymectomy in the various nonmyasthenic immune syndromes for which it has been tried. Based on this review, it seems appropriate to revisit a more active role for Thymectomy in pure red cell aplasia, pemphigus, rheumatoid arthritis, autoimmune hemolytic anemia, and ulcerative colitis.

  • determinants of complete resection of thymoma by minimally invasive and open Thymectomy analysis of an international registry
    Journal of Thoracic Oncology, 2017
    Co-Authors: Bryan M Burt, Joseph B Shrager, Alberto Antonicelli, Sukhmani K Padda, Jonathan Reiss, Heather A Wakelee, Stacey Su, James Huang, Walter J Scott
    Abstract:

    Abstract Introduction Minimally invasive Thymectomy (MIT) is a surgical approach to Thymectomy that has more favorable short-term outcomes for myasthenia gravis than open Thymectomy (OT). The oncologic outcomes of MIT performed for thymoma have not been rigorously evaluated. We analyzed determinants of complete (R0) resection among patients undergoing MIT and OT in a large international database. Methods The retrospective database of the International Thymic Malignancy Interest Group was queried. Chi-square and Wilcoxon rank sum tests, multivariate logistic regression models, and propensity matching were performed. Results A total of 2514 patients underwent Thymectomy for thymoma between 1997 and 2012; 2053 of them (82%) underwent OT and 461 (18%) underwent MIT, with the use of MIT increasing significantly in recent years. The rate of R0 resection among patients undergoing OT was 86%, and among those undergoing MIT it was 94% ( p p  = 0.7). Multivariate analyses were performed to identify determinants of R0 resection. Factors independently associated with R0 resection were geographical region, later time period, less advanced Masaoka stage, total Thymectomy, and the absence of radiotherapy. Surgical approach, whether minimally invasive or open, was not associated with completeness of resection. Conclusions The use of MIT for resection of thymoma has been increasing substantially over time, and MIT can achieve rates of R0 resection for thymoma similar to those achieved with OT.

  • extended transcervical Thymectomy the ultimate minimally invasive approach
    The Annals of Thoracic Surgery, 2010
    Co-Authors: Joseph B Shrager
    Abstract:

    The ideal operative technique for Thymectomy in myasthenia gravis remains controversial. Most surgeons perform Thymectomy through median sternotomy; more recently, thoracoscopic and robotic approaches have been described. "Extended transcervical Thymectomy" is an out-patient procedure that appears less morbid and costly than other approaches. It allows a complete extracapsular thymic resection. Kaplan-Meier complete stable remission rates after transcervical Thymectomy are 33% and 35% at 3 and 6 years (higher including patients remaining on single-drug immunosuppression). The major surgical complication rate is 0.7%. We believe that this less morbid and less costly operation is a very reasonable choice in the surgical treatment of myasthenia gravis.

Amelia Evoli - One of the best experts on this subject based on the ideXlab platform.

  • long term effect of Thymectomy plus prednisone versus prednisone alone in patients with non thymomatous myasthenia gravis 2 year extension of the mgtx randomised trial
    Lancet Neurology, 2019
    Co-Authors: Gil I Wolfe, Greg Minisman, Claudio Mazia, Jeannine M Heckmann, Henry J. Kaminski, Inmaculada Aban, Joel Oger, Alexander Marx, Philipp Ströbel, Amelia Evoli
    Abstract:

    Summary Background The Thymectomy Trial in Non-Thymomatous Myasthenia Gravis Patients Receiving Prednisone (MGTX) showed that Thymectomy combined with prednisone was superior to prednisone alone in improving clinical status as measured by the Quantitative Myasthenia Gravis (QMG) score in patients with generalised non-thymomatous myasthenia gravis at 3 years. We investigated the long-term effects of Thymectomy up to 5 years on clinical status, medication requirements, and adverse events. Methods We did a rater-blinded 2-year extension study at 36 centres in 15 countries for all patients who completed the randomised controlled MGTX and were willing to participate. MGTX patients were aged 18 to 65 years at enrolment, had generalised non-thymomatous myasthenia gravis of less than 5 years' duration, had acetylcholine receptor antibody titres of 1·00 nmol/L or higher (or concentrations of 0·50–0·99 nmol/L if diagnosis was confirmed by positive edrophonium or abnormal repetitive nerve stimulation, or abnormal single fibre electromyography), had Myasthenia Gravis Foundation of America Clinical Classification Class II–IV disease, and were on optimal anticholinesterase therapy with or without oral corticosteroids. In MGTX, patients were randomly assigned (1:1) to either Thymectomy plus prednisone or prednisone alone. All patients in both groups received oral prednisone at doses titrated up to 100 mg on alternate days until they achieved minimal manifestation status. The primary endpoints of the extension phase were the time-weighted means of the QMG score and alternate-day prednisone dose from month 0 to month 60. Analyses were by intention to treat. The trial is registered with ClinicalTrials.gov, number NCT00294658. It is closed to new participants, with follow-up completed. Findings Of the 111 patients who completed the 3-year MGTX, 68 (61%) entered the extension study between Sept 1, 2009, and Aug 26, 2015 (33 in the prednisone alone group and 35 in the prednisone plus Thymectomy group). 50 (74%) patients completed the 60-month assessment, 24 in the prednisone alone group and 26 in the prednisone plus Thymectomy group. At 5 years, patients in the Thymectomy plus prednisone group had significantly lower time-weighted mean QMG scores (5·47 [SD 3·87] vs 9·34 [5·08]; p=0·0007) and mean alternate-day prednisone doses (24 mg [SD 21] vs 48 mg [29]; p=0·0002) than did those in the prednisone alone group. 14 (42%) of 33 patients in the prednisone group, and 12 (34%) of 35 in the Thymectomy plus prednisone group, had at least one adverse event by month 60. No treatment-related deaths were reported during the extension phase. Interpretation At 5 years, Thymectomy plus prednisone continues to confer benefits in patients with generalised non-thymomatous myasthenia gravis compared with prednisone alone. Although caution is appropriate when generalising our findings because of the small sample size of our study, they nevertheless provide further support for the benefits of Thymectomy in patients with generalised non-thymomatous myasthenia gravis. Funding National Institutes of Health, National Institute of Neurological Disorders and Stroke.

Anthony P C Yim - One of the best experts on this subject based on the ideXlab platform.

  • video assisted thoracic surgery Thymectomy the better approach
    The Annals of Thoracic Surgery, 2010
    Co-Authors: Innes Y P Wan, Anthony P C Yim
    Abstract:

    Minimally invasive video-assisted thoracic surgery (VATS) Thymectomy has evolved significantly over the last decade. The most common indication for VATS Thymectomy is the treatment of myasthenia gravis (MG). Video-assisted thoracic surgery Thymectomy results in less postoperative pain, better preserved pulmonary function, and improved cosmesis, which can be particularly important to many young female MG patients. Results of VATS Thymectomy, in terms of complete stable remission from MG and symptomatic improvement, as well as safety, are comparable with conventional surgical techniques. This more patient-friendly approach would lead to wider acceptance by MG patients and their neurologists for earlier thymectomies and improved outcomes.

  • video assisted thoracic surgery Thymectomy for nonthymomatous myasthenia gravis
    Chest, 2005
    Co-Authors: Anthony V Manlulu, Innes Y P Wan, Tak Wai Lee, Chun Yat Law, Carlin Chang, Juan C Garzon, Anthony P C Yim
    Abstract:

    Study objectives: Minimal-access Thymectomy has become increasingly popular as surgical treatment for patients with nonthymomatous myasthenia gravis (NTMG) because of its comparable efficacy, safety, and lesser degree of tissue trauma compared with conventional open surgery. We reviewed and analyzed our data on video-assisted thoracic surgery (VATS) Thymectomy and present the clinical outcomes according to the Myasthenia Gravis Foundation of America classification. Design: A retrospective review of VATS Thymectomy for NTMG in a university hospital over a 12-year period. Data were collected from the medical records and supplemented with telephone surveys. The impact of surgery and other variables potentially affecting complete stable remission (CSR) were calculated using Kaplan-Meier survival curves; comparisons between survival curves was performed using the log-rank test. Results: A total of 38 consecutive patients underwent VATS Thymectomy for NTMG. Median postoperative stay was 3 days. Pathologic examination revealed thymic hyperplasia in 61.1% of cases, normal thymus in 22.2%, and thymic atrophy in 16.6%. There was no perioperative mortality; complications occurred in four patients. After a median follow-up of 69 months, 91.6% of patients experienced improvement, with crude CSR achieved in 22.2%. Kaplan-Meier survival curve demonstrated a 75% CSR rate at 10-year follow-up. On univariate analysis, only disease duration ≤ 12 months (p = 0.03) was associated with a statistically significant improvement in CSR. Conclusions: VATS Thymectomy for NTMG results in symptomatic improvement in the vast majority of patients, with a high rate of CSR. The procedure is associated with low morbidity and no perioperative mortality. Future studies on Thymectomy for myasthenia gravis should be reported in a standardized manner to allow accurate comparisons between results in the absence of randomized prospective trials.

  • video assisted thoracoscopic Thymectomy for myasthenia gravis
    Chest, 1995
    Co-Authors: Anthony P C Yim, R Kay
    Abstract:

    Video-assisted thoracoscopic surgery (VATS) provides a new approach to Thymectomy. From June 1993 to December 1994, we performed a total of eight thymectomies for myasthenia gravis (MG). There were four male and four female patients with ages ranging from 9 to 76 years. Three of the eight patients had associated thymoma. We believe that complete Thymectomy was accomplished in all cases by examination of the thymic bed and resected specimen. There was no mortality or intraoperative complications. The median postoperative hospital stay was 5 days (range, 2 to 37 days). One patient required ventilatory support postoperatively. Clinical improvement was observed in all patients after a mean follow-up of 10 months (range, 2 to 21 months). Compared with a comparable historical group of patients with MG who underwent transsternal Thymectomy, the VATS group was associated with significantly less analgesic requirement and shortened hospital stay. We conclude that VAT Thymectomy is technically feasible and is associated with a favorable postoperative course compared with the transsternal approach. We believe that complete Thymectomy can be achieved by this approach. Further investigation with long-term follow-up is needed to further clarify the role of VAT Thymectomy in thoracic surgery.

Alfred Jaretzki - One of the best experts on this subject based on the ideXlab platform.

  • Thymectomy for nonthymomatous myasthenia gravis a critical analysis
    Annals of the New York Academy of Sciences, 2008
    Co-Authors: Alfred Jaretzki, Joshua R Sonett
    Abstract:

    There continues to be debate concerning which Thymectomy technique is the procedure of choice in the treatment of nonthymomatous myasthenia gravis (MG). The debate persists primarily because of the lack of controlled prospective studies but also because of the varying presentations and clinical courses of MG patients. Analysis has been complicated by the absence, until very recently, of accepted objective definitions of severity of the illness and response to therapy as well as variable patient selection, timing of surgery, type of surgery, and methods of analysis of results. Without resolution of these issues by properly designed prospective studies, there can be no unequivocally valid comparison of the various Thymectomy techniques. In this review, attempts have been made to clarify some of the controversial issues concerning the selection of a Thymectomy technique in the treatment of nonthymomatous MG and to make limited recommendations based on the best available evidence.

  • Thymectomy in the management of myasthenia gravis
    Seminars in Neurology, 2004
    Co-Authors: Alfred Jaretzki, Kenneth M Steinglass, Joshua R Sonett
    Abstract:

    There continues to be a debate regarding the effectiveness of Thymectomy in the treatment of nonthymomatous myasthenia gravis (MG) and, when undertaken, which Thymectomy technique is the procedure of choice. The debate persists primarily because of the lack of controlled prospective studies. Analysis has been complicated by the absence, until very recently, of accepted objective definitions of severity of the illness and response to therapy as well as variable patient selection, timing of surgery, type of surgery, and methods of analysis of results. Without resolution of these issues by properly controlled prospective studies, there can be no unequivocal determination of the effectiveness of Thymectomy or valid comparison of the various Thymectomy techniques. In this review, based on previous analyses, attempts will be made to clarify some of the controversial issues concerning Thymectomy for nonthymomatous MG and make limited recommendations based on the best available evidence.

  • Thymectomy for myasthenia gravis analysis of the controversies regarding technique and results
    Neurology, 1997
    Co-Authors: Alfred Jaretzki
    Abstract:

    Thymectomy is effective in the treatment of myasthenia gravis (MG) and, in the opinion of many, should be the cornerstone of therapy for patients with generalized symptoms. Controversy persists, however, as to which operation is the procedure of choice. To resolve this controversy, those analyzing the results of Thymectomy must understand the reasons for the differing opinions, the goal of surgery, the potential of the various surgical techniques for achieving total Thymectomy, and the problems in the analysis of results. This report discusses these problems and presents evidence that there is a direct relationship between the extent of thymic resection and the results obtained. Although arguments may be presented to refute some of the statements herein, it is hoped that this analysis will lead to better understanding and to resolution of the controversy, standardization of measurements, and the adoption of accepted analytic techniques. The technical goal of Thymectomy in the treatment of MG is complete removal of all thymic tissue. [1-15] It is established that the thymus plays a central role in the pathogenesis of this autoimmune illness. Pathologic and immunologic studies support this thesis. [16-18] Complete neonatal Thymectomy prevents experimental autoimmune myasthenia gravis, whereas incomplete removal does not. [19] In addition, clinically incomplete resections have been a cause of failure requiring reoperation. [20-24] As little as 3 g of residual thymus has caused severe symptoms, and its removal was therapeutic. [21] Contrary to common perception, the anatomy of the human thymus is complex. It consists of multiple lobes in the neck and mediastinum, often not contiguous, as well as gross and microscopic thymic tissue widely and invisibly distributed in cervical and mediastinal fat [25] (Figure 1). Complete removal cannot be ascertained by visual inspection at surgery, and gross and microscopic thymic tissue may be overlooked unless en bloc resection …