Document Detail


Comparative clinical outcomes of thymectomy for myasthenia gravis performed by extended transsternal and minimally invasive approaches.
MedLine Citation:
PMID:  19161744     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: Both transsternal and video-assisted thoracoscopic surgery (VATS) approaches are used for thymectomy in myasthenia gravis. We compared outcomes of simultaneous experiences in two institutions: one utilizing the transsternal approach exclusively, the other using VATS procedures for all patients. The Myasthenia Gravis Foundation of America guidelines were used to standardize reporting. METHODS: Between March 1992 and September 2006, 95 thymectomies were performed for myasthenia gravis; 48 by VATS and 47 by transsternal approach. Preoperative classification and postoperative disease status were compared between the groups. RESULTS: Mean age was 39.8 +/- 14.9 (VATS) versus 34.4 +/- 13.2 years (transsternal) (p = 0.07); the proportion of females was 52% versus 67% (p = 0.15); and preoperative duration of myasthenia gravis was 27 +/- 44 versus 20 +/- 45 months (p = 0.43), respectively. Clinical follow up was 89.5% complete at a mean of 6.0 +/- 4.0 years and 4.3 +/- 2.9 years (p = 0.03). The operative time was 128 +/- 34 minutes (VATS) versus 119 +/- 27 minutes (transsternal) (p = 0.22). The need for postoperative ventilation was 4.2% versus 16.2% (p = 0.07) and mean length of stay was 1.9 +/- 2.6 versus 4.6 +/- 4.2 days (p < 0.001). Thymomas were found in 8.3% of VATS versus 13.3% of transsternal patients (p = 0.44). No myasthenia gravis related deaths occurred and 95.8% of the VATS and 97.9% of the transsternal patients were in either complete stable remission, pharmacologic remission, or minimal manifestations status. In the VATS group, 13 of 17 (76.5%) patients stopped prednisone usage after surgery versus 5 of 14 (35.7%) in the transsternal group (p = 0.022). CONCLUSIONS: Thymectomy is an effective treatment in patients with myasthenia gravis with equivalent clinical outcomes obtained by either approach.
Authors:
Dan M Meyer; Morley A Herbert; Nasin C Sobhani; Paul Tavakolian; Andrea Duncan; Michelle Bruns; Kevin Korngut; Janet Williams; Syma L Prince; L Huber; Gil I Wolfe; Michael J Mack
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Publication Detail:
Type:  Comparative Study; Journal Article; Multicenter Study    
Journal Detail:
Title:  The Annals of thoracic surgery     Volume:  87     ISSN:  1552-6259     ISO Abbreviation:  Ann. Thorac. Surg.     Publication Date:  2009 Feb 
Date Detail:
Created Date:  2009-01-23     Completed Date:  2009-02-11     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  15030100R     Medline TA:  Ann Thorac Surg     Country:  Netherlands    
Other Details:
Languages:  eng     Pagination:  385-90; discussion 390-1     Citation Subset:  AIM; IM    
Affiliation:
Department of Thoracic and Cardiovascular Surgery, University of Texas Southwestern Medical Center at Dallas, Dallas, Texas 75390-8879, USA. danm.meyer@utsouthwestern.edu
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MeSH Terms
Descriptor/Qualifier:
Adult
Cohort Studies
Female
Follow-Up Studies
Humans
Length of Stay
Male
Middle Aged
Myasthenia Gravis / diagnosis,  surgery*
Pain, Postoperative / physiopathology
Probability
Retrospective Studies
Risk Assessment
Surgical Procedures, Minimally Invasive / methods
Thoracic Surgery, Video-Assisted / adverse effects,  methods*
Thoracotomy / adverse effects,  methods*
Thymectomy / adverse effects,  methods*
Treatment Outcome

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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