Document Detail


Long-term outcome of thoracoscopic extended thymectomy for nonthymomatous myasthenia gravis.
MedLine Citation:
PMID:  19339195     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: Thoracoscopic thymectomy has shown promise in the integrated management of myasthenia gravis (MG) although there is still scant data on long-term results. The aim of this study was to analyze long-term (>5 years) results of thoracoscopic extended thymectomy in nonthymomatous MG. METHODS: We retrospectively reviewed 32 patients operated on between 1995 and 2003. MG foundation of America clinical classification (MGFA), symptoms' duration, preoperative crisis, anticholinesterase-drugs dosage, steroid use, and acetylcholine receptor antibodies were evaluated in all patients with annual follow-up. Anti-MuSK antibody titer was also assessed at the last follow-up. RESULTS: There were 21 females and 11 males with a median age of 36 years. Ten patients were seronegative for acetylcholine receptor antibodies. Patients in MGFA class I, II, III and IV were 7 (22%), 15 (44%), 9 (28%), 2 (6%) patients, respectively. Median symptoms duration was 11 months. There was no mortality or major morbidity. Median hospital stay was 4.0 days. Ectopic thymic tissue was found in 18 (56%) patients. Median follow-up was 119 months (range 60-156 months). There was no residual thoracic pain. Estimated 10-year remission rate was 50%. At 72 months, 27 (84.3%) patients were improved or in complete remission. At the univariate analysis, shorter duration of symptoms (<12 months) and absence of oropharyngeal involvement were both predictors of response to thymectomy (p<0.02) whereas positivity for anti-MuSK antibody was a predictor of non-response (p=0.0007). CONCLUSIONS: Thoracoscopic extended thymectomy yields satisfactory long-term results in patients with nonthymomatous myasthenia gravis although anti-MuSK positivity correlated with poor response to operation.
Authors:
Eugenio Pompeo; Federico Tacconi; Roberto Massa; Davide Mineo; Sarit Nahmias; Tommaso Claudio Mineo
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Publication Detail:
Type:  Journal Article; Research Support, Non-U.S. Gov't     Date:  2009-03-31
Journal Detail:
Title:  European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery     Volume:  36     ISSN:  1873-734X     ISO Abbreviation:  Eur J Cardiothorac Surg     Publication Date:  2009 Jul 
Date Detail:
Created Date:  2009-06-22     Completed Date:  2009-10-19     Revised Date:  2009-11-19    
Medline Journal Info:
Nlm Unique ID:  8804069     Medline TA:  Eur J Cardiothorac Surg     Country:  Germany    
Other Details:
Languages:  eng     Pagination:  164-9     Citation Subset:  IM    
Affiliation:
Department of Thoracic Surgery, Myasthenia Gravis Unit, Policlinico Tor Vergata University, Rome, Italy. pompeo@med.uniroma2.it
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MeSH Terms
Descriptor/Qualifier:
Adult
Autoantibodies / blood
Biological Markers / blood
Choristoma / complications
Female
Follow-Up Studies
Humans
Male
Middle Aged
Myasthenia Gravis / complications,  surgery*
Receptor Protein-Tyrosine Kinases / immunology
Receptors, Cholinergic / immunology
Remission Induction
Retrospective Studies
Thoracic Surgery, Video-Assisted / methods*
Thymectomy / methods*
Thymus Gland
Treatment Outcome
Chemical
Reg. No./Substance:
0/Autoantibodies; 0/Biological Markers; 0/Receptors, Cholinergic; EC 2.7.10.1/MUSK protein, human; EC 2.7.10.1/Receptor Protein-Tyrosine Kinases

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