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1.
Cancer Imaging ; 19(1): 80, 2019 Dec 02.
Artigo em Inglês | MEDLINE | ID: mdl-31791411

RESUMO

BACKGROUND: Thymoma is a rare tumor that originates from thymic epithelial cells and is usually associated with myasthenia gravis. Radiofrequency ablation (RFA) is a minimally invasive and curative treatment for other tumors, but RFA has not been used for the early treatment of thymoma. METHODS: The current study included 13 patients with stage I thymoma who were not candidates for surgical resection or video-assisted thoracoscopic surgery (VATS). All patients underwent first-line CT-guided percutaneous RFA. The feasibility and therapeutic effects of the intervention were thoroughly documented. RESULTS: All tumors were completely ablated (13 / 13, 100%). During follow-up (median 80.5 months, range, 64.6-116.9 months), only 1 of the 13 patients had recurrence of thymoma (1 / 13, 7.7%) at 35.5 months after the initial ablation. There were no surgery-related deaths after RFA treatment. The most common complications were fever (13 / 13, 100%) and pain (13 / 13, 100%). There was only one patient who occurred severe puncture-related bleeding during the procedure that needed blood transfusion and intravascular embolization of the punctured-injured vessel. CONCLUSION: CT-guided percutaneous RFA for treatment of stage I thymoma is associated with minor trauma, few complications and good treatment outcomes.


Assuntos
Ablação por Cateter/métodos , Cirurgia Assistida por Computador/métodos , Timoma/cirurgia , Neoplasias do Timo/cirurgia , Adolescente , Adulto , Ablação por Cateter/efeitos adversos , Criança , Estudos de Viabilidade , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Cirurgia Assistida por Computador/efeitos adversos , Timoma/diagnóstico por imagem , Timoma/patologia , Neoplasias do Timo/diagnóstico por imagem , Neoplasias do Timo/patologia , Tomografia Computadorizada por Raios X , Resultado do Tratamento , Adulto Jovem
2.
Khirurgiia (Mosk) ; (12): 132-136, 2019.
Artigo em Russo | MEDLINE | ID: mdl-31825354

RESUMO

The problem of giant chest tumors is still actual despite the progress in diagnostics of intrathoracic cancer. Surgical treatment of giant tumors should always be considered as a part of combined antitumor treatment. Large tumor is not a contraindication for surgery per se. The results of explorative thoracotomy may be assessed in expert centers once again if redo surgery may be followed by favorable outcome. These operations require the coordinated work of the entire operating team.


Assuntos
Toracotomia/efeitos adversos , Timoma/cirurgia , Neoplasias do Timo/cirurgia , Terapia Combinada , Síndromes Compartimentais/etiologia , Humanos , Timoma/terapia , Neoplasias do Timo/terapia
3.
Medicine (Baltimore) ; 98(51): e18359, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31860993

RESUMO

BACKGROUND: The completeness of resection is an important prognostic factor for early resectable thymoma. Since its inception 2 decades ago, median sternotomy has been recognized as the gold standard method for the treatment of all types and stages of thyomas. Minimally invasive surgical techniques, including video-assisted and robot-assisted surgery, have been rapidly developed as an alternative to traditional open approach surgery. Compared with traditional open approach surgery, minimally invasive approach has better cosmetic effect, faster improvement of lung function, reduction of surgical trauma, length of stay, and complications. We believe that this is an appropriate time and there is a need for a systematic, comprehensive, and objective assessment of the 2 surgical modalities in order to provide reliable evidence for clinicians to determine the best treatment for patients with early resectable thymoma. METHODS: Pubmed (Medline), Web of Science, Embase, Cochrane Central Register of Controlled Trials, and Google Scholar will be searched for relevant randomized controlled trials (RCTs), quasi-RCTs, and Hi-Q (high quality) prospective cohort trials published or unpublished in any language before March 1, 2020. Subgroup analysis will be performed in tumor pathological stage and ethnicity. PROSPERO registration number: CRD42019133724. RESULTS: The results of this study will be published in a peer-reviewed journal. CONCLUSION: This study will be the first to assess the efficacy and safety of median sternotomy recognized as the gold standard method for the treatment of all types and stages of thyomas and minimally invasive thymectomy for patients with early-stage thymoma. This study will assess whether minimally invasive thoracoscopic and robotic assisted thymectomy can be used as an alternative to traditional median sternotomy for patients with early resectable thymoma and provide high-quality and reliable evidence for clinicians' decision-making.


Assuntos
Procedimentos Cirúrgicos Minimamente Invasivos , Esternotomia , Timectomia/métodos , Timoma/cirurgia , Neoplasias do Timo/cirurgia , Humanos , Metanálise como Assunto , Revisão Sistemática como Assunto
4.
Kyobu Geka ; 72(12): 993-996, 2019 Nov.
Artigo em Japonês | MEDLINE | ID: mdl-31701909

RESUMO

The patient was a 70-year-old woman who was found to have 2 mediastinal tumors on chest computed tomography(CT). One was located in the anterior mediastinum, and the other was in the upper mediastinum. Based on previous imaging studies, it was revealed that the 2 tumors had been increasing in size for 5 years. Thymectomy via median sternotomy was performed. Histopathologically, 3 tumors revealed to be in the thymus without direct invasion of the adjacent organs. All were thymic squamous cell carcinomas of 3.0×1.8×1.6 cm, 2.5×1.6×1.2 cm and 0.7 cm in size. No lymphatic invasion was observed and all tumors were pathologically stage I. Thus, we considered the 3 tumors were multi-centric primary tumors.


Assuntos
Neoplasias do Mediastino , Timoma , Neoplasias do Timo , Idoso , Feminino , Humanos , Mediastino , Timectomia , Timoma/cirurgia , Neoplasias do Timo/cirurgia
5.
Kyobu Geka ; 72(12): 1031-1033, 2019 Nov.
Artigo em Japonês | MEDLINE | ID: mdl-31701916

RESUMO

A 50-year-old man was admitted to our hospital for severe pneumonia. An anterior mediastinum tumor and the hypogammaglobulinaemia were detected during treatment of pneumonia, and Good's syndrome was diagnosed. The clinical characteristics of Good's syndrome are increased susceptibility to bacterial infections and opportunistic viral and fungal infections. We planned thymectomy with the perioperative supplementation of immunoganmmagloblin to prevent perioperative infectious complications after pneumonia recovered completely. Extended thymo-thymectomy was performed. Pathological examination revealed type AB thymoma. The hypogammaglobulinaemia did not improved following thymectomy, and the patient had to be treated by immunoglobulin supplementation to maintain adequate trough immunoglobulin G( IgG) values.


Assuntos
Agamaglobulinemia , Síndromes de Imunodeficiência , Timoma , Neoplasias do Timo , Humanos , Síndromes de Imunodeficiência/complicações , Masculino , Pessoa de Meia-Idade , Timectomia , Timoma/complicações , Timoma/cirurgia , Neoplasias do Timo/complicações , Neoplasias do Timo/cirurgia
6.
J Cardiothorac Surg ; 14(1): 182, 2019 Oct 29.
Artigo em Inglês | MEDLINE | ID: mdl-31665049

RESUMO

BACKGROUND: The authors presented a 63-year old female synchronously complicated with a thymic tumor located at the left-side of the superior mediastinum, and a paravertebral tumor located at the right-side of the lower thorax. Conventional thoracoscopic surgical procedure using rigid instruments to simultaneously resect the two tumors via the same ports might be technically challenging. To our knowledge, the use of a surgical robot allowed the surgeon to perform precise dissection from extreme angles with the characteristic of articulating surgical instruments. CASE PRESENTATION: Two lesions were successfully dissected using the da Vinci Surgical System through the same four ports on the right side of the chest and two-step docking. Firstly, the patient cart came from the dorsal side of the patient and the paravertebral neoplasm was dissected. Afterwards, the patient cart was undocked and the operation table was rotated 180 degrees counterclockwise. The robot was re-introduced and the patient cart came from the ventral side of the patient and the whole thymus was resected. CONCLUSION: This case report suggests that two-step docking via the same four ports for these two tumors located at different directions of the thorax was safe and effective, demonstrating a clear advantage of the surgical robot.


Assuntos
Cisto Broncogênico/cirurgia , Neoplasias do Mediastino/cirurgia , Neoplasias Primárias Múltiplas/cirurgia , Neurilemoma/cirurgia , Neoplasias do Timo/cirurgia , Cisto Broncogênico/diagnóstico por imagem , Cisto Broncogênico/patologia , Feminino , Humanos , Neoplasias do Mediastino/diagnóstico por imagem , Neoplasias do Mediastino/patologia , Pessoa de Meia-Idade , Neoplasias Primárias Múltiplas/diagnóstico por imagem , Neoplasias Primárias Múltiplas/patologia , Neurilemoma/diagnóstico por imagem , Neurilemoma/patologia , Procedimentos Cirúrgicos Robóticos/métodos , Vértebras Torácicas , Toracoscopia/métodos , Timectomia/métodos , Neoplasias do Timo/diagnóstico por imagem , Neoplasias do Timo/patologia , Tomografia Computadorizada por Raios X
7.
Magy Seb ; 72(3): 83-97, 2019 Sep.
Artigo em Húngaro | MEDLINE | ID: mdl-31544487

RESUMO

Introduction: Thymectomy became an important part of the treatment of myasthenia gravis, since Alfred Blalock reported about his first surgery 80 years ago. Despite of several different surgical techniques already accepted abroad, sternal approach was the almost exclusive exposure for thymectomy in Hungary till 2006. In this publication, we analyze the direct surgical consequences and complications of this method. Methods: At the Surgical Department of Budai MÁV Hospital, 1002 transsternal thymectomies were performed during 34 years on patients suffering from myasthenia gravis. Surgeries were performed for neurological indications, following careful medical investigations, involving specialists in neurology and internal medicine. In cases associated with thymoma, surgery was indicated for two reasons: removal of the thymus and the tumor at the same time. Neurological indications, patient preparation, perioperative treatment and surgical technique have considerably changed during these 34 years. We interpret the results according to the two eras based on the most frequently applied surgical techniques (simple and extended thymectomy); we publish the data separately of the patients with thymoma and those who underwent repeated surgery, focusing basically on breath-related complications. Results: The patients' age was 32 years on the average (8-73 years). Women/men ratio: 3.5:1. Myasthenia gravis was associated with thymoma in 12.7% of the patients. Repeated thymectomy was necessary in case of 11 patients; further two patients required repeated sternotomy after cardiac surgery. Respiratory failure occurred in 21,3% out of 525 myasthenic patients operated in the first 19-year-old era, emergency re-intubation and tracheostomy happened in 12,8% and in 11,2% as well. In the second 15-year-old period postoperative respiratory failure occurred in 12,7% with emergency re-intubation in 7,1% and tracheostomy only in 1,2% out of 338 myasthenic patients. Respiratory failure occurred in 19.1% out of 126 patients operated for thymoma; re-intubation was necessary in 12.8% of the cases and tracheostomy was performed in 20.6% of the patients. Respiratory failure occurred in 13 patients, who underwent repeated surgery (46.1%); the ratio of re-intubation was 15.4% and that of tracheostomies 46.1%. Serious surgical complications were infrequent also in the entire group of patients: 2 patients required repeated surgery due to sternal bleeding; one more patient underwent repeated surgery due to rupture of the drainage tube, 4 cases of mediastinitis in the first group, two cases of heart injury and one case of sternal disruption occurred in the second period. The overall mortality was 1.4%: 1.3% in the first period, 0.3% in the second period, 4% in the thymoma group and 7.7% after repeated surgeries. Conclusions: In a historical overview, the ratio of serious respiratory and airway complications and the mortality after transsternal thymectomies has considerably decreased, but the postoperative respiratory failure and the surgical risk of transsecting the sternum still pose a real risk.


Assuntos
Miastenia Gravis/cirurgia , Esterno/cirurgia , Timectomia/métodos , Timoma/cirurgia , Neoplasias do Timo/cirurgia , Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Miastenia Gravis/patologia , Cuidados Pré-Operatórios , Timoma/patologia , Neoplasias do Timo/patologia , Resultado do Tratamento
8.
BMJ Case Rep ; 12(8)2019 Aug 02.
Artigo em Inglês | MEDLINE | ID: mdl-31377716

RESUMO

Thymoma-associated multiorgan autoimmunity is a relatively new term to describe the rare paraneoplastic syndrome that complicates thymoma, which can involve the thyroid, liver and intestine in addition to the skin. The pathology often indicates a graft-versus-host-like pattern commonly observed in recipients of an allogeneic haematopoietic cell transplant. We report a case of type B2 and B3 thymoma with invasion to the lung and pleura in a patient who presented with oral lichen planus and graft-versus-host-like erythroderma. The cutaneous lesions improved after complete resection of the thymoma in combination with systemic glucocorticoids, which was subsequently complicated by cytomegalovirus pneumonitis.


Assuntos
Doenças Autoimunes/tratamento farmacológico , Glucocorticoides/uso terapêutico , Timoma/cirurgia , Neoplasias do Timo/cirurgia , Doenças Autoimunes/etiologia , Terapia Combinada , Glucocorticoides/efeitos adversos , Humanos , Biópsia Guiada por Imagem , Líquen Plano Bucal/etiologia , Pulmão/diagnóstico por imagem , Pulmão/patologia , Masculino , Pessoa de Meia-Idade , Invasividade Neoplásica , Pleura/patologia , Timoma/complicações , Timoma/patologia , Neoplasias do Timo/complicações , Neoplasias do Timo/patologia
9.
World J Surg Oncol ; 17(1): 151, 2019 Aug 28.
Artigo em Inglês | MEDLINE | ID: mdl-31462247

RESUMO

BACKGROUND: While calcification of thymoma is common, "eggshell" calcification is rare. We report a case of an eggshell calcified thymoma that "hatched" after 4 years of follow-up. Pathologically, it revealed that sarcoidosis accompanied this case of thymoma, which might cause in calcification. CASE PRESENTATION: The patient was a 68-year-old female. A 20-mm anterior mediastinal nodule completely covered with calcification was noted in an annual health check-up. However, as the nodule did not change during 6 months of follow-up, she discontinued regular examinations. Four years later, an abnormality in her chest X-ray was noted again. The tumor grew outside the calcification to reach 63 mm. She underwent resection of this anterior mediastinal tumor. Pathologically, the tumor was diagnosed as thymoma of type B1 in the WHO classification. The histology of the tumor inside and outside of the calcification was not different, suggesting that the tumor grew from the inside of the calcification. The calcification was located within the fibrotic capsule of thymoma. Sarcoidosis also presented in her lung and mediastinal lymph nodes. CONCLUSIONS: Although the mechanism of calcification of the capsule was not clear, sarcoidosis might be related to this case because macrophage accumulation and altered lipid metabolism in sarcoidosis present with similar dystrophic calcification.


Assuntos
Calcinose/patologia , Neoplasias do Mediastino/patologia , Sarcoidose/patologia , Timoma/patologia , Neoplasias do Timo/patologia , Idoso , Calcinose/complicações , Calcinose/cirurgia , Feminino , Humanos , Neoplasias do Mediastino/complicações , Neoplasias do Mediastino/cirurgia , Prognóstico , Sarcoidose/complicações , Sarcoidose/cirurgia , Timoma/complicações , Timoma/cirurgia , Neoplasias do Timo/complicações , Neoplasias do Timo/cirurgia
10.
Kyobu Geka ; 72(6): 438-441, 2019 Jun.
Artigo em Japonês | MEDLINE | ID: mdl-31268016

RESUMO

To prevent graft injury at the thoracic surgery after coronary artery bypass grafting (CABG), thymus is often used to cover the grafts. We report a thymoma that developed 12 years after CABG in a 65-year-old woman. The patient had undergone percutaneous coronary intervention (PCI) with stenting of the left anterior descending( LAD) artery, 13 years ago, and a 4-vessel CABG, 12 years ago. Three-dimensional(3D) coronary computed tomography (CT) and angiography before surgery showed that all grafts were intact, but LAD artery occlusion was presented just distal to the stent. Since the thymoma was located in front of the ascending aorta and trunk of the pulmonary artery, abutting the left and right internal thoracic artery and radial artery graft, we performed PCI for LAD recanalization preoperatively, and complete resection of the thymoma with redo sternotomy was performed safely using an ultrasonic stethoscope without damage to the graft.


Assuntos
Cirurgia Torácica , Timoma , Neoplasias do Timo/cirurgia , Idoso , Angiografia Coronária , Ponte de Artéria Coronária , Feminino , Humanos , Reoperação , Timoma/cirurgia , Resultado do Tratamento
11.
BMJ Case Rep ; 12(7)2019 Jul 17.
Artigo em Inglês | MEDLINE | ID: mdl-31320375

RESUMO

Thymic epithelial tumours (TETs) are rare lesions that represent less than 1% of all malignancies in adults. Presentation occurs in three ways: asymptomatic, with local thoracic symptoms or with paraneoplastic symptoms. Heterotopic ossifications are rare histological features in neoplasms and non-neoplastic lesions. Here, we present a 49-year-old male patient with a thymoma type B2 mimicking an aortic aneurysm. Alongside the thymoma, a cholesterol granuloma with unusual ossification features was found as well. This clinical presentation and pathological diagnosis are unusual findings.


Assuntos
Aneurisma Aórtico/diagnóstico , Calcinose/diagnóstico por imagem , Granuloma/diagnóstico por imagem , Timoma/diagnóstico por imagem , Neoplasias do Timo/diagnóstico por imagem , Aorta/diagnóstico por imagem , Calcinose/cirurgia , Dor no Peito/etiologia , Colesterol , Diagnóstico Diferencial , Granuloma/cirurgia , Humanos , Masculino , Pessoa de Meia-Idade , Timoma/complicações , Timoma/patologia , Timoma/cirurgia , Neoplasias do Timo/complicações , Neoplasias do Timo/patologia , Neoplasias do Timo/cirurgia , Tomografia Computadorizada por Raios X
12.
Cancer Control ; 26(1): 1073274819865281, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31331197

RESUMO

The aim of the study was to evaluate the usefulness of computed tomography (CT) and magnetic resonance imaging (MRI) for differentiating thymoma from nonthymoma abnormalities in patients with myasthenia gravis (MG). A cross-sectional study of 53 patients with MG, who had undergone surgical thymectomy, was conducted at 103 Hospital (Hanoi, Vietnam) and Cho Ray Hospital (Ho Chi Minh City, Vietnam) during August 2014 and January 2017. The CT and MRI images of patients with MG were qualitatively and quantitatively (radiodensity and chemical shift ratio [CSR]) analyzed to determine and compare their ability to distinguish thymoma from nonthymoma abnormalities. Logistic regression was used to identify the association between imaging parameters (eg, CSR) and the thymoma status. The receiver operating curve (ROC) analysis was used to determine the differentiating ability of CSR and radiodensity. As results, of the 53 patients with MG, 33 were with thymoma and 20 were with nonthymoma abnormalities. At qualitative assessment, MRI had significantly higher accuracy than did CT in differentiating thymoma from nonthymoma abnormalities (94.3% vs 83%). At quantitative assessment, both the radiodensity and CSR were significantly higher for thymoma compared with nonthymoma groups (P < .001). The ROC analysis showed that CSR had significantly higher sensitivity (Se) and specificity (Sp) than radiodensity in discriminating between the 2 groups (CSR: Se 100%, Sp 95% vs radiodensity: Se 90.9%, Sp 70%). When combining both qualitative and quantitative parameters, MRI had even higher accuracy than did CT in thymoma diagnosis (P = .031). In conclusion, chemical shift MRI was more accurate than CT for differentiating thymoma from nonthymoma in patients with MG.


Assuntos
Miastenia Gravis/etiologia , Timoma/diagnóstico , Timo/diagnóstico por imagem , Neoplasias do Timo/diagnóstico , Adulto , Estudos Transversais , Diagnóstico Diferencial , Feminino , Humanos , Imagem por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Curva ROC , Timectomia , Timoma/complicações , Timoma/cirurgia , Timo/cirurgia , Neoplasias do Timo/complicações , Neoplasias do Timo/cirurgia , Tomografia Computadorizada por Raios X , Adulto Jovem
13.
Medicine (Baltimore) ; 98(28): e16385, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31305442

RESUMO

RATIONALE: Invasive thymoma with intraluminal tumor thrombus may cause pulmonary artery thrombus if the tumor thrombus shed off during operation. However, there is no clinical case report focused on such complication. PATIENT CONCERNS: A 40-year-old woman presented with repeated chest pain. DIAGNOSIS: Chest computer tomography showed huge mediastinal mass. Postoperative pathology revealed type B2 and B3 thymoma, with B3 as the main type. INTERVENTIONS: The patient underwent tumor resection through midline sternotomy in our hospital on September 17, 2018. She received emergent pulmonary artery exploration because the tumor thrombus in superior vena cava shed off unexpectedly during operation. Postoperative pulmonary computer tomography angiography showed right pulmonary artery embolism. Then emergent right pulmonary artery embolectomy was performed through lateral thoracic incision on September 29, 2018. OUTCOMES: The patient recovered well after surgery. D-dimer reduced rapidly and returned to normal 1 month after the second operation. LESSONS: Intraluminal tumor thrombus in invasive thymoma patients has a risk of shedding off during operation. Prevention strategy should be made beforehand. Pulmonary artery exploration is necessary once happened.


Assuntos
Complicações Intraoperatórias , Embolia Pulmonar/etiologia , Timoma/cirurgia , Neoplasias do Timo/cirurgia , Adulto , Feminino , Humanos , Complicações Intraoperatórias/diagnóstico por imagem , Complicações Intraoperatórias/cirurgia , Embolia Pulmonar/diagnóstico por imagem , Embolia Pulmonar/cirurgia , Reoperação , Timoma/diagnóstico por imagem , Timoma/patologia , Neoplasias do Timo/diagnóstico por imagem , Neoplasias do Timo/patologia
14.
BMC Neurol ; 19(1): 126, 2019 Jun 13.
Artigo em Inglês | MEDLINE | ID: mdl-31195997

RESUMO

BACKGROUND: Autoimmune encephalitis (AE) is a newly recognized autoimmune disorders in which the targets are proteins or receptors involved in synaptic transmission and neuronal excitability. α-amino-3-hydroxy-5-methyl-4-isoxazolepropionic acid receptor (AMPAR) is a subtype of glutamate receptor that mediates most of the fast excitatory neurotransmission in the brain. CASE PRESENTATION: A 50-year-old woman presented with subacute onset of memory loss and behavioral changes. High levels of serum (1:1000) and CSF (1:32) antibodies against the AMPAR GluR2 were detected. A wide range of abnormalities in 6-8 Hz low to middle slow waves was found by electroencephalographs, and high-intensity signals on fluid-attenuated inversion recovery in both the medial temporal lobe and hippocampus were identified on brain magnetic resonance images. This patient presented with myasthenia gravis and type B2 thymoma (World Health Organization Thymoma Classification) at age 48. This case was unique in that the patient initiated with the symptom of myasthenia gravis and thymoma two years prior to encephalitis, and a complete thymectomy was performed before AE onset without recurrence of the thymoma when encephalitis occurred. CONCLUSIONS: Thymoma was reported to be associated with paraneoplastic neurological disease. This is the first time a thymectomy has been applied in a myasthenia gravis patient with thymoma two years prior to the onset of anti-AMPAR2 encephalitis. This case highlights the complexity of autoimmune encephalitis associated with thymoma.


Assuntos
Encefalite/complicações , Doença de Hashimoto/complicações , Miastenia Gravis/complicações , Receptores de AMPA/imunologia , Timoma/complicações , Neoplasias do Timo/complicações , Encefalite/imunologia , Feminino , Doença de Hashimoto/imunologia , Humanos , Imagem por Ressonância Magnética , Pessoa de Meia-Idade , Miastenia Gravis/cirurgia , Timectomia , Timoma/cirurgia , Neoplasias do Timo/cirurgia
15.
Pediatr Surg Int ; 35(7): 749-757, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31119357

RESUMO

BACKGROUND: Thymectomy in pediatric patients is an effective treatment for myasthenia gravis (MG), thymic neoplasms, and other rarer pathologies. It is an uncommon procedure in children and studies have focused on small, single-institution cohorts. We sought to better characterize its use by utilizing a national database. METHODS: The Kids' Inpatient Database was used to identify hospital discharge records of patients ≤ 20 years old who underwent thymectomy. A retrospective cross-sectional analysis for 2003, 2006, 2009, and 2012 was performed. Trends in patient characteristics, diagnosis, surgical approach, and short-term outcomes were analyzed. Risk factors were identified using univariate and multivariate analyses. RESULTS: There were 600 thymectomies identified. MG was the most common indication. Thoracoscopy is being used increasingly for all diagnoses except malignancy. The overall morbidity rate was 14.0%, with respiratory complications representing the largest group. No in-hospital deaths were identified. Private insurance was associated with shorter hospital stays and lower costs. Hispanic race was associated with more complications, longer stays, and higher costs. Thoracoscopic thymectomies had shorter stays than open procedures. CONCLUSION: Thymectomy in the pediatric population is being performed safely, with low morbidity and no identified mortalities. Thoracoscopy results in reduced length of stay and is being used increasingly. Of note, socioeconomic and racial factors impact outcomes.


Assuntos
Miastenia Gravis/cirurgia , Cirurgia Torácica Vídeoassistida/métodos , Timectomia/métodos , Timoma/cirurgia , Neoplasias do Timo/cirurgia , Adolescente , Criança , Estudos Transversais , Feminino , Humanos , Tempo de Internação/tendências , Masculino , Estudos Retrospectivos , Resultado do Tratamento
18.
Khirurgiia (Mosk) ; (3): 84-87, 2019.
Artigo em Russo | MEDLINE | ID: mdl-30938362

RESUMO

The experience of video-assisted thoracoscopic interventions for thymus tumors in the Research Institute of Oncology of Tomsk National Research Medical Center is presented. We also evaluate the features of postoperative management of these patients.


Assuntos
Cirurgia Torácica Vídeoassistida/métodos , Timectomia/métodos , Timoma/cirurgia , Neoplasias do Timo/cirurgia , Humanos , Cuidados Pós-Operatórios , Resultado do Tratamento
19.
Ann Thorac Surg ; 108(2): 405-411, 2019 08.
Artigo em Inglês | MEDLINE | ID: mdl-30953650

RESUMO

BACKGROUND: Minimally invasive thymectomy (MIT) has demonstrated improved short-term outcomes compared with open thymectomy (OT). Although adoption of MIT for thymoma is increasing, oncologic outcomes have not been well characterized. METHODS: This was a retrospective cohort study of adult patients from the National Cancer Database who underwent MIT or OT for Masaoka stage I to II thymoma between 2010 and 2014. The primary outcome was R0 resection. Secondary outcomes included MIT use, perioperative mortality, and length of stay. RESULTS: Nine hundred forty-three patients from 395 hospitals underwent thymectomy for stage I to II thymoma. MIT was performed in 31.3% (59.7% robotic, 40.3% thoracoscopic). Over the study period MIT utilization increased from 21.0% to 40.2% (trend test, p < 0.001). R0 resection was achieved in 83.1% of MITs (86.6% stage I, 72.7% stage II) and 79% of OTs (85.5% stage I, 65.8% stage II). In multivariable analyses, the likelihood of incomplete resection (R1/2) was associated with stage II tumors (odds ratio, 2.51) and World Health Organization B3 histology (odds ratio, 3.66). R0 resection was not associated with surgical approach (p = 0.17) and did not vary with tumor size (trend test, p = 0.90). Mortality rates at 30 and 90 days were 0% and 0.5%, respectively. MIT was associated with significantly shorter lengths of stay than OT (-1.03 days [95% confidence interval, -1.68 to -0.38]). CONCLUSIONS: The use of MIT for resection of early-stage thymoma is increasing and is not associated with lower rates of R0 resection than OT. Reasons for the relatively low rates of R0 resection among all thymectomies requires further investigation, and long-term outcomes data are needed to better define the oncologic effectiveness of MIT.


Assuntos
Margens de Excisão , Estadiamento de Neoplasias/métodos , Robótica/métodos , Timectomia/métodos , Timoma/cirurgia , Neoplasias do Timo/cirurgia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Taxa de Sobrevida/tendências , Timoma/diagnóstico , Timoma/mortalidade , Neoplasias do Timo/diagnóstico , Neoplasias do Timo/mortalidade , Estados Unidos/epidemiologia , Adulto Jovem
20.
Thorac Surg Clin ; 29(2): 203-213, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-30928002

RESUMO

About 15% of patients with myasthenia gravis are affected by thymoma. Precise tumor staging is necessary to plan the appropriate operation. In early stages, complete surgical resection is the mainstay of treatment. Minimally invasive approaches can be safely performed by highly trained surgeons, and may be preferred in myasthenic patients because they can ensure optimal results from the oncological, neurologic, and surgical point of views, avoiding the complications of open approach. For advanced stage thymoma in myasthenic patients, a careful, multidisciplinary planning of the therapeutic approach must be undertaken, particularly for extended resections involving the lung and great vessels.


Assuntos
Miastenia Gravis/cirurgia , Timectomia , Timoma/cirurgia , Neoplasias do Timo/cirurgia , Tomada de Decisão Clínica , Humanos , Miastenia Gravis/etiologia , Cuidados Pré-Operatórios , Procedimentos Cirúrgicos Robóticos , Cirurgia Torácica Vídeoassistida , Timoma/complicações , Neoplasias do Timo/complicações
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