Non-Small Cell Lung Cancer Invading the Descending Thoracic Aorta: Surgical Resection Without Using Cardiopulmonary Bypass and Without Cross-Clamping the Aorta: Long-Term Follow-Up of 2 Cases.

Lung cancer can sometimes invade vital adjacent mediastinal structures, such as the descending thoracic aorta. We describe 2 cases where pulmonary resection was performed en bloc including a patch of the descending thoracic aorta. These procedures were easily performed using an aortic endoprosthesis in the same anesthetic procedure. We also comment some aspects about an intraoperative endoleak, postoperative evolution, and long-term follow-up.

Is the prognosis of occult N2 disease similar to that of positive positron emission tomography-computed tomography (PET/CT) scan single-station N2 disease in patients with non-small cell lung cancer treated by surgical resection? / ¿Es el pronóstico de la enfermedad N2 oculta mediastínica similar al de la enfermedad N2 estación única por tomografía de emisión de positrones-tomografía computarizada (PET-TC) en pacientes con cáncer de pulmón no célula pequeña tratados con resección quirúrgica?

Objective. A retrospective study, using a prospective database, was conducted on patients treated with surgery in order to analyze the prognosis between two groups: NSCLC (non-small cell lung cancer) patients with occult N2 disease and patients with single station N2 disease observed on pre-operative integrated PET/CT scan. Methods. A total of 772 patients underwent surgical treatment for lung cancer from January 2007 to December 2014. All of them had an integrated PET/CT scan in the pre-operative work-up and a pulmonary resection plus mediastinal lymphadenectomy were performed in all cases. In the selected cases, no one received induction treatment. All patients from both groups had N2 disease after examination of the histopathology specimen. Clinical and pathological characteristics, disease free survival, and overall survival, were analyzed in both groups. Results. A total of 34 cases presented occult N2 disease, whereas 11 cases showed single station N2 disease on pre-operative PET/CT scan. Mean disease free survival and mean overall survival for occult N2 disease compared to single-station N2 disease on PET/CT scan was 36.0 months (95% CI: 24.9-47.1) and 38.9 months (95% CI: 20.6-57.1), p=.586; and 52.3 months (95% CI: 38.9-65.7) and 38.2 months (95% CI: 21.9-54.5), p=.349, respectively. Conclusion. The prognosis of patients with single-station N2 disease on PET/CT scan treated by surgical resection and mediastinal lymphadenectomy as first line treatment was similar to those with occult N2 disease. More studies are needed to support our findings (AU)

Objetivo. Estudio retrospectivo de una base de datos prospectiva sobre pacientes tratados con cirugía para analizar el pronóstico entre dos grupos: pacientes con cáncer de pulmón no células pequeñas con enfermedad N2 oculta y pacientes con enfermedad N2 estación única observados en el estudio preoperatorio con PET/TC integrado. Métodos. Desde enero de 2007 hasta diciembre de 2014 un total de 772 pacientes fueron operados por cáncer de pulmón. Todos los pacientes tuvieron una PET/TC en el estudio preoperatorio y se les realizó la resección pulmonar más linfadenectomía mediastínica. En los casos seleccionados no hubo tratamiento de inducción. Todos los pacientes de ambos grupos fueron N2 después del examen anatomopatológico. Se analizaron las características clinicopatológicas, la supervivencia libre de enfermedad y la supervivencia global de ambos grupos. Resultados. Un total de 34 casos fueron enfermedad N2 oculta, mientras que 11 casos mostraron enfermedad N2 con estación única en el estudio preoperatorio con PET/TC. La supervivencia libre de enfermedad y la supervivencia media global para la enfermedad N2 oculta comparada con la enfermedad N2 con estación ganglionar mediastínica única fue de 36,0 meses (IC 95%: 24,9-47,1) y 38,9 meses (IC 95%: 20,6-57,1) p=0,586 y de 52,3 meses (IC 95%: 38,9-65,7) y 38,2 meses (IC 95%: 21,9-54,5) p=0,349, respectivamente. Conclusión. El pronóstico de los pacientes con enfermedad N2 de estación única en PET/TC tratados con cirugía y linfadenectomía mediastínica como primera línea de tratamiento fue similar a aquellos con enfermedad N2 oculta. Más estudios son necesarios para apoyar nuestros resultados (AU)

Is the prognosis of occult N2 disease similar to that of positive positron emission tomography-computed tomography (PET/CT) scan single-station N2 disease in patients with non-small cell lung cancer treated by surgical resection?

OBJECTIVE: A retrospective study, using a prospective database, was conducted on patients treated with surgery in order to analyze the prognosis between two groups: NSCLC (non-small cell lung cancer) patients with occult N2 disease and patients with single station N2 disease observed on pre-operative integrated PET/CT scan. METHODS: A total of 772 patients underwent surgical treatment for lung cancer from January 2007 to December 2014. All of them had an integrated PET/CT scan in the pre-operative work-up and a pulmonary resection plus mediastinal lymphadenectomy were performed in all cases. In the selected cases, no one received induction treatment. All patients from both groups had N2 disease after examination of the histopathology specimen. Clinical and pathological characteristics, disease free survival, and overall survival, were analyzed in both groups. RESULTS: A total of 34 cases presented occult N2 disease, whereas 11 cases showed single station N2 disease on pre-operative PET/CT scan. Mean disease free survival and mean overall survival for occult N2 disease compared to single-station N2 disease on PET/CT scan was 36.0 months (95% CI: 24.9-47.1) and 38.9 months (95% CI: 20.6-57.1), p=.586; and 52.3 months (95% CI: 38.9-65.7) and 38.2 months (95% CI: 21.9-54.5), p=.349, respectively. CONCLUSION: The prognosis of patients with single-station N2 disease on PET/CT scan treated by surgical resection and mediastinal lymphadenectomy as first line treatment was similar to those with occult N2 disease. More studies are needed to support our findings.

Omentoplastia y packing intratorácico simple para cerrar una fístula broncopleural derecha postneumonectomía y evitar la toracostomía / Omentoplasty and simple thoracic acking to close a right postp-neumonectomy bronchopleural fistula and to avoid thoracostomy

Un varón de 77 años con múltiples factores de riesgo desarrolló 13 días después de una neumonectomía derecha una fístula broncopleural de 8 mm. Fue reoperado utilizando un colgajo de epiplon para cubrir el muñón bronquial y el mediastino sin suturarlo al muñon bronquial. El colgajo de epiplon simplemente se colocó sobre el mediastino cubriendo ampliamente el muñón. Permaneció sujeto en su posición con varios puntos sobre el orificio transdiafragmático y pericardio y con múltiples compresas empaquetadas ocupando toda la cavidad pleural para comprimir el epiplon desplegado sobre el mediastino. El drenaje torácico se conectó a aspiración para evitar acúmulo de derrame pleural infectado y la toracotomía se cerró. Las compresas que formaban el packing intratorácico se cambiaron cada dos días. El colgajo de epiplon quedó agarrado firmemente al mediastino y la fístula del bronquio derecho cerró completamente. El paciente fue dado de alta 14 días después de la omentoplastia y en el seguimiento no aparecieron signos de recidiva de la fístula broncopleural

A 77-year-old male patient with high risks factors developed 13 days after pneumonectomy a 8 mm-size bronchopleural fistula. He was reoperated on using an omentum flap to cover the bronchial stump and the mediastinum without suturing the bronchial stump. The omentum flap was just laid on the right mediastinal site to cover widely the stump, and was kept in place by applying some stiches to the diaphragm and to the pericardium, and also several dressings inside the postpneumonectomy thoracic cavity to completely pack the omentum against the mediastinum. A chest tube was connected to suction to avoid accumulation of infected pleural effusion, and thoracostomy was closed. The packing of intrathoracic dressings were changed every 2 days. The omentum flap got intensely attached to the mediastinum and the right main bronchial fistula completely healed. Patient was discharged 14 days after omentoplasty, and no signs of fistula relapse appeared in the follow-up

Omentoplastia y packing intratorácico simple para cerrar una fístula broncopleural derecha postneumonectomía y evitar la toracostomía / Omentoplasty and simple thoracic packing to close a right post-pneumonectomy bronchopleural fistula and to avoid thoracostomy

Un varón de 77 años con múltiples factores de riesgo desarrolló 13 días después de una neumonectomía derecha una fístula broncopleural de 8mm. Fue reoperado utilizando un colgajo de epiplon para cubrir el muñón bronquial y el mediastino sin suturarlo al muñon bronquial. El colgajo de epiplon simplemente se colocó sobre el mediastino cubriendo ampliamente el muñón. Permaneció sujeto en su posición con varios puntos sobre el orificio transdiafragmático y pericardio y con múltiples compresas empaquetadas ocupando toda la cavidad pleural para comprimir el epiplon desplegado sobre el mediastino. El drenaje torácico se conectó a aspiración para evitar acúmulo de derrame pleural infectado y la toracotomía se cerró. Las compresas que formaban el packing intratorácico se cambiaron cada dos días. El colgajo de epiplon quedó agarrado firmemente al mediastino y la fístula del bronquio derecho cerró completamente. El paciente fue dado de alta 14 días después de la omentoplastia y en el seguimiento no aparecieron signos de recidiva de la fístula broncopleural

A 77-year-old male patient with high risks factors developed 13 days after pneumonectomy a 8mm-size bronchopleural fistula. He was reoperated on using an omentum flap to cover the bronchial stump and the mediastinum without suturing the bronchial stump. The omentum flap was just laid on the right mediastinal site to cover widely the stump, and was kept in place by applying some stiches to the diaphragm and to the pericardium, and also several dressings inside the postpneumonectomy thoracic cavity to completely pack the omentum against the mediastinum. A chest tube was connected to suction to avoid accumulation of infected pleural effusion, and thoracostomy was closed. The packing of intrathoracic dressings were changed every 2 days. The omentum flap got intensely attached to the mediastinum and the right main bronchial fistula completely healed. Patient was discharged 14 days after omentoplasty, and no signs of fistula relapse appeared in the follow-up

Ratio between maximum standardized uptake value of N1 lymph nodes and tumor predicts N2 disease in patients with non-small cell lung cancer in 18F-FDG PET-CT scan / La relación entre el SUV (standardized uptake value) de los ganglios linfáticos N1 y el tumor predice la enfermedad N2 en pacientes con cáncer de pulmón no célula pequeña mediante PET-TC 18F-FDG (AU)

Objective. F-18 fluorodeoxyglucose integrated PET-CT scan is commonly used in the work-up of lung cancer to improve preoperative disease stage. The aim of the study was to analyze the ratio between SUVmax of N1 lymph nodes and primary lung cancer to establish prediction of mediastinal disease (N2) in patients operated on non-small cell lung cancer. Material and method. This is a retrospective study of a prospective database. Patients operated on non-small cell lung cancer (NSCLC) with N1 disease by PET-CT scan were included. None of them had previous induction treatment, but they underwent standard surgical resection plus systematic lymphadenectomy. Results. There were 51 patients with FDG-PET-CT scan N1 disease. 44 (86.3%) patients were male with a mean age of 64.1 ± 10.8 years. Type of resection: pneumonectomy = 4 (7.9%), lobectomy/bilobectomy = 44 (86.2%), segmentectomy = 3 (5.9%). Histology: adenocarcinoma = 26 (51.0%), squamous = 23 (45.1%), adenosquamous = 2 (3.9%). Lymph nodes after surgical resection: N0 = 21 (41.2%), N1 = 12 (23.5%), N2 = 18 (35.3%). Mean ratio of the SUVmax of N1 lymph node to the SUVmax of the primary lung tumor (SUVmax N1/T ratio) was 0.60 (range 0.08-2.80). ROC curve analysis to obtain the optimal cut-off value of SUVmax N1/T ratio to predict N2 disease was performed. At multivariate analysis, we found that a ratio of 0.46 or greater was an independent predictor factor of N2 mediastinal lymph node metastases with a sensitivity and specificity of 77.8% and 69.7%, respectively. Conclusions. SUVmax N1/T ratio in NSCLC patients correlates with mediastinal lymph node metastasis (N2 disease) after surgical resection. When SUVmax N1/T ratio on integrated PET-CT scan is equal or superior to 0.46, special attention should be paid on higher probability of N2 disease (AU)

Objetivo. La PET-TC integrada con F-18 fluorodeoxiglucosa es utilizada frecuentemente en la estadificación preoperatoria del cáncer de pulmón(CP). El objetivo del estudio fue analizar la relación entre SUVmax de los ganglios linfáticos N1 con el tumor pulmonar para establecer un factor predictivo de enfermedad metastásica ganglionar en el mediastino(N2) en pacientes operados de cáncer de pulmón no microcítico. Material y método. Estudio retrospectivo de una base de datos prospectiva. Se incluyeron pacientes operados de CP con enfermedad N1 por PET-TC. Ninguno tuvo tratamiento previo. Se realizó una resección pulmonar estándar y linfadenectomía. Resultados. Hubo un total de 51 pacientes con N1 por PET-TC. 44(86,3%) fueron varones, edad media = 64,1 ± 10,8 años. Tipo de resección: neumonectomía = 4(7,9%), lobectomía/bilobectomía = 44(86,2%), segmentectomía = 3(5,9%). Histología: adenocarcinoma = 26(51,0), epidermoide = 23(45,1%), adenoescamoso = 2(3,9%). Ganglios linfáticos tras la resección: N0 = 21(41,2%), N1 = 12(23,5%), N2 = 18(35,3%). La relación media entre el SUVmax de los ganglios N1 con el SUVmax del tumor pulmonar (relación SUVmax N1/T) fue 0,60 (rango 0,08–2,80). El análisis de la curva ROC se realizó para determinar el punto de corte óptimo para predecir N2 (metástasis mediastínica). En el análisis multivariante encontramos que una relación de 0,46 o mayor fue un factor pronóstico independiente para N2, con una sensibilidad y especificidad de 77,8% y 69,7%, respectivamente. Conclusiones. La relación SUVmax N1/T en pacientes con CP no microcítico se correlaciona con la metástasis ganglionar mediastínica (N2) después de la resección quirúrgica. Cuando la relación SUVmax N1/T en la PET-TC es igual o mayor de 0,46 se debería prestar atención especial por la alta probabilidad de enfermedad mediastínica N2 (AU)

Ratio between maximum standardized uptake value of N1 lymph nodes and tumor predicts N2 disease in patients with non-small cell lung cancer in 18F-FDG PET-CT scan.

OBJECTIVE: F-18 fluorodeoxyglucose integrated PET-CT scan is commonly used in the work-up of lung cancer to improve preoperative disease stage. The aim of the study was to analyze the ratio between SUVmax of N1 lymph nodes and primary lung cancer to establish prediction of mediastinal disease (N2) in patients operated on non-small cell lung cancer. MATERIAL AND METHOD: This is a retrospective study of a prospective database. Patients operated on non-small cell lung cancer (NSCLC) with N1 disease by PET-CT scan were included. None of them had previous induction treatment, but they underwent standard surgical resection plus systematic lymphadenectomy. RESULTS: There were 51 patients with FDG-PET-CT scan N1 disease. 44 (86.3%) patients were male with a mean age of 64.1±10.8 years. Type of resection: pneumonectomy=4 (7.9%), lobectomy/bilobectomy=44 (86.2%), segmentectomy=3 (5.9%). HISTOLOGY: adenocarcinoma=26 (51.0%), squamous=23 (45.1%), adenosquamous=2 (3.9%). Lymph nodes after surgical resection: N0=21 (41.2%), N1=12 (23.5%), N2=18 (35.3%). Mean ratio of the SUVmax of N1 lymph node to the SUVmax of the primary lung tumor (SUVmax N1/T ratio) was 0.60 (range 0.08-2.80). ROC curve analysis to obtain the optimal cut-off value of SUVmax N1/T ratio to predict N2 disease was performed. At multivariate analysis, we found that a ratio of 0.46 or greater was an independent predictor factor of N2 mediastinal lymph node metastases with a sensitivity and specificity of 77.8% and 69.7%, respectively. CONCLUSIONS: SUVmax N1/T ratio in NSCLC patients correlates with mediastinal lymph node metastasis (N2 disease) after surgical resection. When SUVmax N1/T ratio on integrated PET-CT scan is equal or superior to 0.46, special attention should be paid on higher probability of N2 disease.

Estenosis traqueosubglótica postintubación. Obstrucción aguda de la vía aérea: manejo de la urgencia y tratamiento definitivo / Post-intubation subglottal-tracheal stenosis: Acute airway obstruction: management of the emergency and final treatment

Presentamos el caso de un varón de 46 años que consultó por disnea y estridor 8 meses después de sufrir un infarto agudo de miocardio e intubación orotraqueal. Se sospechó una estenosis traqueal que se agravó repentinamente. La urgencia de la vía aérea se trató con dilataciones progresivas mediante broncoscopio rígido y antiinflamatorios. En un segundo tiempo se realizó la intervención quirúrgica con resección traqueosubglótica de la zona estenótica y reconstrucción laringotraqueal. Comentamos algunos detalles sobre los aspectos técnicos de la intervención (AU)

We present the case of a 46-year-old man who consulted due to dyspnea and stridor 8 months after suffering an acute heart attack requiring orotracheal ventilation. Tracheal stenosis was suspected, with sudden worsened. The airway emergency was treated with rigid bronchoscopy and progressive dilations of the stenosis. At a second time, surgical subglottal-tracheal resection of the stenotic segment and laryngotracheal reconstruction were performed. We also comment on some of the technical details of the operation (AU)

[Pulmonary torsion complicating lobectomy: report of 2 cases]. / Torsión pulmonar como complicación de una lobectomía pulmonar, descripción de dos casos.

We report 2 cases of pulmonary torsion discovered during the early postoperative recovery of patients who had undergone lobectomy. Early diagnosis, based on chest radiography and confirmed by computed tomography, meant we were able to avoid major surgical resection and the development of further complications. Pulmonary torsion is a rare but potentially serious abnormality. Prompt diagnosis is the key to preventing tissue injury and complications such as necrotizing pneumonitis, thromboembolic disease, or septic shock. Among the diagnostic tests that can be carried out if there is good reason to suspect torsion, we emphasize simple chest radiography and fiberoptic bronchoscopy, supported by computed tomography or arteriography, even though a firm diagnosis requires surgical exploration of the affected lung. Definitive treatments range from reversing the torsion and securing the lung to resecting the lung if the parenchymal tissue has been fully compromised.

Torsión pulmonar como complicación de una lobectomía pulmonar, descripción de dos casos / Pulmonary torsion complicating lobectomy: report of 2 cases

Descripción de dos casos de torsión pulmonar enpacientes intervenidos de lobectomía por neoplasia pulmonar.Se muestran dos pacientes que sufrieron complicaciónde torsión de lóbulo pulmonar tras realizarselobectomía pulmonar aparecida en el postoperatorioinmediato. Se realizó el diagnóstico precoz mediante unaradiografía del tórax y la confirmación mediante unTAC, que indicó la toracotomía la cual evitó mayorresección quirúrgica y aparición de otras complicaciones.La torsión pulmonar es una alteración infrecuentepero de potencial gravedad. El diagnóstico precoz es devital importancia para evitar el compromiso tisular yprevenir complicaciones como neumonitis necrotizante,enfermedad tromboembólica o shock séptico. Entre laspruebas diagnósticas que pueden llevar a la alta sospechadiagnóstica destacamos la radiología simple de tóraxy fibrobroncoscopia, apoyadas por la tomografía axial ola arteriografía, aunque el diagnóstico definitivo es laexploración quirúrgica del parénquima afecto. El tratamientodefinitivo abarca desde la simple detorsión y fijacióndel pulmón, hasta resección pulmonar o neumonectomíasi el compromiso tisular es completo(AU)

We report 2 cases of pulmonary torsion discoveredduring the early postoperative recovery of patients whohad undergone lobectomy. Early diagnosis, based onchest radiography and confirmed by computedtomography, meant we were able to avoid major surgicalresection and the development of further complications.Pulmonary torsion is a rare but potentially seriousabnormality. Prompt diagnosis is the key to preventingtissue injury and complications such as necrotizingpneumonitis, thromboembolic disease, or septic shock.Among the diagnostic tests that can be carried out ifthere is good reason to suspect torsion, we emphasizesimple chest radiography and fiberoptic bronchoscopy,supported by computed tomography or arteriography,even though a firm diagnosis requires surgicalexploration of the affected lung. Definitive treatmentsrange from reversing the torsion and securing the lungto resecting the lung if the parenchymal tissue has beenfully compromised(AU)

Involución de seudotumor inflamatorio de pulmón localmente invasivo / No disponible

El seudotumor inflamatorio pulmonar (SIP) es una patología benigna, inusual en adultos. Frecuentemente es necesario recurrir a la resección quirúrgica para efectuar el diagnóstico diferencial con lesiones neoplásicas. Debido al elevado porcentaje de recidivas, el tratamiento de elección es la resección completa. Presentamos el caso de una paciente con un voluminoso SIP en el lóbulo superior izquierdo, que se manifestó con invasión de pared torácica anterior y del mediastino. Tras una biopsia incisional parietal y una resección pulmonar atípica por minitoracotomía vídeo asistida, la lesión remanente presentó una involución espontánea. Un seguimiento exhaustivo, demostró ausencia de recidivas durante 30 meses (AU)

No disponible

Plasmocitoma solitario de esternón. Presentación de un caso y revisión de la literatura / Isolated plasmacytoma of the sternum: presentation of a case and review

La localización del plasmocitoma a nivel esternales excepcional. Se presenta el caso de un pacientecon una tumoración en la región del manubrio esternal,sin diagnóstico de certeza a pesar de la PAAF yde la biopsia incisional efectuadas. Se realizó unaresección con amplios márgenes de la lesión, reconstruyendoel defecto con una malla de polipropileno.Los resultados postoperatorios fueron satisfactorios.Se efectúa una revisión de la literatura

The localization of plasmacytoma in the sternumis exceptional. A patient suspected of having a sternalmanubrium tumor, without a clear diagnosisdespite a fine needle aspiration biopsy and an incisionbiopsy is presented. A wide margin resectionof the lesion and reconstruction with a polypropylenemesh were undertaken. The results were satisfactory.A review of the literature is made

[Pneumocephalus and cerebrospinal fluid fistula following removal of a superior sulcus tumor (pancoast tumor)]. / Neumoencéfalo y fístula de líquido cefalorraquídeo tras resección de tumor del sulcus superior (tumor de Pancoast).

Pneumocephalus resulting from a subarachnoid-pleural fistula following resection of a pulmonary neoplasm is a very rare postoperative complication: we have found only 17 cases in the literature. We report the case of a 65-year-old man diagnosed with a superior sulcus tumor who underwent a left upper lobectomy and costal resection following neoadjuvant radiation therapy. Soon after surgery, the patient developed a subarachnoid-pleural fistula and pneumocephalus that required reoperation and drainage. Recurrence was suspected when chronic aseptic meningitis developed. Another thoracotomy was required to resolve the complication.

Tumor desmoide de la pared torácica / Desmoid tumor of the chest wall

No disponible

Condrosarcoma gigante de pared torácica / Giant chondrosarcoma of the chest wall

No disponible

[Thymectomy in myasthenia gravis]. / Timectomía en la miastenia gravis.

OBJECTIVE: To analyze outcome after thymectomy in patients with myasthenia gravis (MG). MATERIAL AND METHODS: Thirty-five patients with MG underwent surgery in our service between June 1987 and June 1998. Ten had associated thymomas. Preoperative Osserman classification showed 2 at level I, 20 at level IIA, 11 at level IIB and 2 at level III. Extended thymectomy through a medial sternotomy was performed in all. RESULTS: Postoperative complications developed in three patients (1 medullary aplasia, 1 postoperative reintubation, 1 myasthenic crisis). Mean follow-up was 89 months, with 22.8% achieving complete remission and 97.1% reporting improvements. The results were similar in the 10 patients with thymomas (20% full remission and 90% showing improvement). By DeFilippi classification, 22.8% were in class 1, 22.8% in class 2, 51.4% in class 3 and 2.8% in class 4. By Osserman classification, 9 were in the same category before and after surgery, 12 had improved one level, 10 had improved 2 levels, 3 had improved 3 levels and 1 patient had improved 4 levels. CONCLUSION: Thymectomy is an appropriate therapeutic procedure in the multidisciplinary treatment of patients with MG and it is the approach of choice for patients with associated thymomas. The intra- and post-operative complication rate is low and the rate of clinical improvement is high.

Timectomía en la miastenia gravis / Thymectomy in myasthenia gravis

OBJETIVO: Analizar los resultados de la timectomía en pacientes con miastenia gravis. MATERIAL Y MÉTODOS: Entre junio de 1987 y junio de 1998, se intervinieron en nuestro servicio 35 pacientes con miastenia gravis, en 10 de los cuales se asociaban timomas. Los pacientes se clasificaron en el preoperatorio según la clasificación de Osserman (dos grado I, 20 grado IIA, 11 grado IIB y dos grado III). En todos se realizó timectomía ampliada por esternotomía media. RESULTADOS: En 3 pacientes hubo complicaciones postoperatorias (una aplasia medular, una reintubación postoperatoria y una crisis miasténica). Tras una mediana de seguimiento de 89 meses, el 22,8 por ciento estaba en remisión completa y el 97,1 por ciento había mejorado. Los resultados son similares en los 10 pacientes con timoma (un 20 por ciento de remisiones completas y un 90 por ciento de mejorías). Según la clasificación de DeFilippi un 22,8 por ciento se encontraba en clase 1; un 22,8 por ciento, en clase 2; un 51,4 por ciento, en clase 3, y un 2,8 por ciento, en clase 4. Según la clasificación de Osserman, 9 pacientes presentaban el grado previo a la cirugía, 12 habían mejorado un grado, 10 habían mejorado 2 grados, 3 habían mejorado 3 grados y un paciente había mejorado 4 grados. CONCLUSIÓN: La timectomía es una opción terapéutica adecuada en el tratamiento multidisciplinario de los pacientes con miastenia gravis y es el tratamiento de elección en los pacientes en que se asocian timomas. El porcentaje de complicaciones intra y postoperatorias es bajo, y se obtiene un índice elevado de mejorías clínicas (AU)