Minimally invasive thymectomy for myasthenia gravis: a 7-year retrospective study

Jian Gao; Chun Jin; Yong-Qiang Ao; Jie Tang; Jian-Yong Ding; Ji-Hong Dong; Jia-Hao Jiang

doi:10.21037/gs-21-756

Minimally invasive thymectomy for myasthenia gravis: a 7-year retrospective study

Gland Surg. 2021 Dec;10(12):3342-3350. doi: 10.21037/gs-21-756.

Authors

Jian Gao^#¹, Chun Jin^#^{1

2}, Yong-Qiang Ao¹, Jie Tang³, Jian-Yong Ding¹, Ji-Hong Dong⁴, Jia-Hao Jiang¹

Affiliations

¹ Department of Thoracic Surgery, Zhongshan Hospital, Fudan University, Shanghai, China.
² Department of Thoracic Surgery, Changhai hospital, Naval Military Medical University, Shanghai, China.
³ Department of Anesthesiology, Zhongshan Hospital, Fudan University, Shanghai, China.
⁴ Department of Neurology, Zhongshan Hospital, Fudan University, Shanghai, China.

^# Contributed equally.

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.

Keywords: Myasthenia gravis (MG); bilateral approach; subxiphoid approach; thymic mass; video-assisted thoracic surgery (VATS).