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1.
BMJ Case Rep ; 15(1)2022 Jan 13.
Artigo em Inglês | MEDLINE | ID: mdl-35027385

RESUMO

A 41-year-old female presented with dysgeusia, dry eyes, nyctalopia with progressive visual field constriction (due to autoimmune retinopathy) and gastrointestinal symptoms (due to ulcerative colitis). She was subsequently admitted to intensive care with a myasthenic crisis, and CT of the thorax demonstrated a thymoma.Following thymectomy and adjuvant radiotherapy, she has remained in complete remission from her ulcerative colitis and myasthenia gravis, her retinopathy has stabilised and there has been no thymoma recurrence over a 10-year postoperative period. There was a brief relapse of her dysgeusia (causing weight loss) and dry eye symptoms 3 years after her surgery, which resolved 8 months later. While the association of thymomas with paraneoplastic syndromes (PNS) is well established, it is unusual to present with multiple PNS, and some of these have only been documented in sparse case reports to date. Thymectomy played a crucial role in improvement and stabilisation of her PNS.


Assuntos
Colite Ulcerativa , Síndromes do Olho Seco , Ceratoconjuntivite Seca , Miastenia Gravis , Doenças Retinianas , Timoma , Neoplasias do Timo , Adulto , Colite Ulcerativa/complicações , Disgeusia , Feminino , Humanos , Miastenia Gravis/complicações , Miastenia Gravis/diagnóstico , Recidiva Local de Neoplasia , Timectomia , Timoma/complicações , Timoma/diagnóstico , Timoma/cirurgia , Neoplasias do Timo/complicações , Neoplasias do Timo/diagnóstico , Neoplasias do Timo/cirurgia
2.
Heart Lung Circ ; 31(1): 59-68, 2022 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-34509374

RESUMO

OBJECTIVE: The optimal extent of surgical resection for non-myasthenic patients with thymoma is controversial. The objective of this meta-analysis was to compare complete to partial thymectomy in non-myasthenic patients for oncological and postoperative clinical outcomes. METHODS: We performed a PubMed and EMBASE search (from inception to January 2020) for English-language studies directly comparing partial thymectomy (thymomectomy) to complete thymectomy for thymoma resection. Clinical endpoints studied included overall and disease-free survival, Masaoka and World Health Organization staging, adjuvant therapy, postoperative complications, postoperative drainage, length of hospital stay, thymoma-related deaths, postresection development of myasthenia gravis, incomplete resection, and recurrence. Random effects meta-analyses across all clinical endpoints was done. RESULTS: There was no statistically significant difference between the two approaches with regard to recurrence (odds ratio [OR], 1.22; 95% confidence interval [CI], 0.78-1.92), completeness of resection (OR, 1.17; 95% CI, 0.66-2.10), adjuvant therapy (OR, 0.71; 95% CI, 0.40-1.26), or thymoma-related deaths (OR, 0.76; 95% CI, 0.12-4.66). There was a statistically significant decrease in postoperative complications (OR, 0.61; 95% CI, 0.39-0.97), drainage (mean difference [MD], -0.99; 95% CI, -1.98 to -0.01), and length of hospital length (MD, -1.88; 95% CI, -3.39 to -0.36) with partial thymectomy. CONCLUSIONS: The evidence appeared to suggest that partial thymectomy is oncologically equivalent to complete thymectomy for non-myasthenic patients with early-stage thymoma. There is an additional advantage of reduced postoperative complications and decreased length of hospital stay with partial thymectomy.


Assuntos
Miastenia Gravis , Timoma , Neoplasias do Timo , Humanos , Miastenia Gravis/patologia , Miastenia Gravis/cirurgia , Estadiamento de Neoplasias , Período Pós-Operatório , Estudos Retrospectivos , Timectomia , Timoma/patologia , Timoma/cirurgia , Neoplasias do Timo/patologia , Neoplasias do Timo/cirurgia , Resultado do Tratamento
5.
J Med Case Rep ; 15(1): 616, 2021 Dec 16.
Artigo em Inglês | MEDLINE | ID: mdl-34911585

RESUMO

BACKGROUND: The association of inflammatory myopathy and myasthenia gravis is a rarely described entity whose clinical presentation has always been intriguing because of the great clinical similarity between these two pathologies. The presence of a thymic pathology often explains this combination, whose mechanisms are very complex. CASE PRESENTATION: A 56-year-old woman of North African origin, was hospitalized to explore the Raynaud phenomenon associated with proximal muscle weakness, pain, and arthralgia. There was no rash, and neuromuscular examination had revealed proximal tetraparesis and mild neck weakness. Tendon reflexes were normal. There was no abnormal nail fold capillaroscopy. A significant titer of muscle enzymes had been shown on blood tests, and autoimmune screening for myositis-specific and myositis-associated autoantibodies was negative. Electromyography had shown a myopathic pattern, and muscle biopsy confirmed an inflammatory myopathy. Although steroids were introduced, the clinical course was unsatisfactory; ophthalmic and bulbar symptomatology appeared. The association of myasthenia gravis was confirmed by an elevated level of serum acetylcholine receptor. A chest computed tomography scan had identified a thymoma. Treated with prednisone, pyridostigmine, and thymectomy, the patient's clinical and biological evolution was favorable. CONCLUSION: This case illustrates an exceptional association of two entities and the difficulty encountered during their diagnosis and treatment. The management of these two diseases is different, so it is essential to recognize this concomitant presentation.


Assuntos
Miastenia Gravis , Miosite , Timoma , Neoplasias do Timo , Feminino , Humanos , Pessoa de Meia-Idade , Miastenia Gravis/complicações , Miastenia Gravis/diagnóstico , Miastenia Gravis/tratamento farmacológico , Miosite/complicações , Miosite/diagnóstico , Timectomia , Timoma/diagnóstico , Timoma/diagnóstico por imagem , Neoplasias do Timo/diagnóstico , Neoplasias do Timo/diagnóstico por imagem
6.
J Transl Med ; 19(1): 413, 2021 10 02.
Artigo em Inglês | MEDLINE | ID: mdl-34600541

RESUMO

BACKGROUND: The length of time for clinical improvement of patients with thymomatous myasthenia gravis (MG) after extended thymectomy is not clear. The purpose of this study was to determine the length of time after thymectomy in patients with thymomatous MG to achieve a 3-point reduction of Quantitative Myasthenia Gravis Score (QMGS), and identify variables associated with a failure to achieve the reduction. METHODS: The records of patients with thymomatous MG who underwent extended thymectomy from January 2005 to December 2018 were retrospectively reviewed. The primary end point was a reduction of 3 points of QMGs and the secondary end point was another reduction of 3 points of QMGs. RESULTS: A total of 481 patients were included in the analysis, the mean age of the patients was 41.63 ± 8.55 years, and approximately 60% were male. The median time to achieve a 3 point decrease in QMGS was 6 months, and the median time to achieve another 3 point decrease was 30 months. Multivariable analysis indicated that age ≥ 42 years and Masaoka-Koga stage > I were associated with a lower probability of achieving a 3 point decrease in QMGS (HR = 0.55 and 0.65, respectively). Likewise, multivariable analysis indicated that age ≥ 42 years and Masaoka-Koga stage > I were associated with a lower probability of achieving a second 3 point decrease in QMGS (HR = 0.53 and 0.53, respectively). CONCLUSIONS: In patients with thymomatous MG who receive thymectomy, age ≥ 42 years and Masaoka-Koga stage > I are associated with a worse prognosis and failure to achieve a 3 point decrease in QMGS.


Assuntos
Miastenia Gravis , Timoma , Neoplasias do Timo , Adulto , Humanos , Masculino , Pessoa de Meia-Idade , Miastenia Gravis/complicações , Miastenia Gravis/cirurgia , Estudos Retrospectivos , Timectomia , Resultado do Tratamento
7.
Artigo em Inglês | MEDLINE | ID: mdl-34672144

RESUMO

Robotic thymectomy is the most innovative surgical approach for treating disease of the anterior mediastinum. Robotic surgery offers low postoperative morbidity, faster recovery, shorter hospital stay, and better cosmetic results, without compromising surgical radicality. During the operation, the patient is placed in a supine position at the left edge of the operating table with the left hemithorax upward; the position is maintained with sandbags. The target area for the autodocking should be toward the jugulum. The first surgical step is to isolate the inferior thymic horns via the dissection that starts from the inferior portion of the mediastinal tissue and proceeds toward the right side, following the contralateral pleural reflection. Afterward, it is necessary to move toward the superior horns, following the phrenic nerve, the first landmark, to the innominate vein, our second landmark. Finally, we dissect the superior horns while searching for the thymic veins, which could appear atrophic, and clip the vessels to safely isolate the innominate vein. During this step, it is useful to use a retraction movement to progressively dissect the horns from the jugulum. The thymus gland is removed en bloc with the perithymus fat using an endoscopic bag inserted through the right port incision.


Assuntos
Procedimentos Cirúrgicos Robóticos , Robótica , Neoplasias do Timo , Humanos , Tempo de Internação , Timectomia
9.
Int J Med Robot ; 17(6): e2333, 2021 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-34533876

RESUMO

BACKGROUND: Recently, thymectomy using minimally invasive approaches has been increasing with the development of robotic video-assisted thoracoscopic surgery (R-VATS). Although multimodal approach is effective for robot assisted thymectomy, it is necessary to determine the approach (left, right or subxiphoid) associated with the least complications. METHODS: An electronic retrieval from PubMed, Embase, Web of Science, GreyNet International and The Cochrane Library. The single-arm meta-analysis was performed to compare the rate of complications of right- and left-side approaches by R-VATS. RESULTS: A total of 21 studies including 930 patients were identified. The pooled incidence of total complications was 12.2% (confidence interval: 10.0%-14.8%) for all studies. The overall complication rate was 17.3% for the right-side compared with 7.4% for the left side (P < 0.001, odds ratio = 2.484, 1.601-3.852). The pooled incidence of air leak was significantly higher for the right versus left side (5.1% vs. 1.2%, respectively; p = 0.004). The incidence of atrial fibrillation was higher for the right-side compared with the left-side approach (4% vs. 1.2%, respectively; p = 0.004). The open conversion rate was significantly higher for the right versus the left-side (6.5% vs. 2.9%, respectively; p = 0.004). However, there was no significant difference in the pooled incidence of pleural effusion and thoracic duct fistula when comparing the right- and left-side approaches. In subgroup analysis, in the left approach, the incidence of overall complications (28.6% vs. 5.5%, respectively; p = 0.002) and pleural effusion (14.3% vs. 1%, respectively; p = 0.002) was higher for the 'Old Age' group compared with the 'Youth' group; However, In the subgroup analysis of gender, there was no significant difference in the incidence of complications after thymectomy. CONCLUSION: Robotic video-assisted thoracoscopic surgery can be performed on the left- and right-sides; however, complications are minimal with the left-side approach. These data demonstrate that the incidence of overall complications, atrial fibrillation, open conversion ratios, and air leak rate of left-side R-VATS thymectomy are lower than those of right-side. Further subgroup analysis showed that the incidence of postoperative complications was higher in the older group.


Assuntos
Robótica , Timectomia , Adolescente , Humanos , Complicações Pós-Operatórias/etiologia , Cirurgia Torácica Vídeoassistida , Timectomia/efeitos adversos , Resultado do Tratamento
10.
Khirurgiia (Mosk) ; (9): 27-33, 2021.
Artigo em Russo | MEDLINE | ID: mdl-34480452

RESUMO

OBJECTIVE: To analyze efficacy and safety of rethymectomy in patients with pathology of thymus. MATERIAL AND METHODS: Nine patients (2 males and 7 females) underwent rethymectomy in the thoracic surgery department of the Hertzen Research Institute of Oncology for the period from March 2009 to December 2019. Initial thymectomy for myasthenia gravis was performed in 6 patients, for thymoma without myasthenia - in 3 patients. Age of patients varied from 27 to 75 years (median 42.8 years). Myasthenia manifested at the age of 25-61 years (median 29.2 years). Period between manifestation and thymectomy varied from 6 to 24 months (median 12.6 months). MGFA grade IIIa was in 1 patient, grade IIIb - in 1, grade IVa - in 1, grade IVb - in 2, grade V - in 1 patient. Rethymectomy was performed via sternotomy in 4 cases, through thoracoscopy - in 5 patients. RESULTS: Postoperative complications occurred in 2 (22.2%) patients. Biopsy revealed residual thymic tissue in all patients. Median follow-up after rethymectomy was 30.2 months (range 12-132 months). Complete stable remission was achieved in 3 (50.0%) patients, remission - in 2 cases, partial remission - in 1 patient. Median dose of steroids before rethymectomy was 40 mg (range 16-96 mg), median dose after rethymectomy - 8 mg (range 0-24 mg). Differences were significant (p=0.04). All patients operated on for thymoma or recurrence are alive within 12-124 months after rethymectomy. CONCLUSION: Rethymectomy is a safe and effective treatment option for patients with refractory myasthenia gravis (especially in case of detected residual thymic tissue) or recurrent thymoma. Radical surgery for recurrent thymoma ensures favorable survival.


Assuntos
Miastenia Gravis , Timoma , Neoplasias do Timo , Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Miastenia Gravis/diagnóstico , Miastenia Gravis/cirurgia , Recidiva Local de Neoplasia , Estudos Retrospectivos , Timectomia/efeitos adversos , Timoma/diagnóstico , Timoma/cirurgia , Neoplasias do Timo/complicações , Neoplasias do Timo/diagnóstico , Neoplasias do Timo/cirurgia , Resultado do Tratamento
11.
J Cardiothorac Surg ; 16(1): 275, 2021 Sep 27.
Artigo em Inglês | MEDLINE | ID: mdl-34579751

RESUMO

BACKGROUND: To explore the risk factors for prolonged ventilation after thymectomy in patients with thymoma associated with myasthenia gravis (TAMG). METHODS: We reviewed the records of 112 patients with TAMG after thymectomy between January 2010 and December 2019 in Peking University People's Hospital. Demographic, pathological, preoperative data and the Anesthesia, surgery details were assessed with multivariable logistic regression analysis to predict the risk of prolonged ventilation after thymectomy. A nomogram to predict the probability of post-thymectomy ventilation was constructed with R software. Discrimination and calibration were employed to evaluate the performance of the nomogram. RESULTS: By multivariate analysis, male, low vital capacity (VC), Osserman classification (IIb, III, IV), total intravenous anesthesia, and long operation time were identified as the risk factors and entered into the nomogram. The nomogram showed a robust discrimination, with an area under the receiver operating characteristic curve (AUC) of 0. 835 (95% confidence interval [CI], 0.757-0.913). The calibration plot indicated that the nomogram-predicted probabilities compared very well with the actual probabilities (Hosmer-Lemeshow test: P = 0.921). CONCLUSION: The nomogram is a valuable predictive tool for prolonged ventilation after thymectomy in patients with TAMG.


Assuntos
Miastenia Gravis , Timoma , Neoplasias do Timo , Anestesia Geral , Humanos , Masculino , Miastenia Gravis/complicações , Miastenia Gravis/cirurgia , Estudos Retrospectivos , Fatores de Risco , Timectomia/efeitos adversos , Timoma/complicações , Timoma/cirurgia
12.
Zhonghua Yi Xue Za Zhi ; 101(31): 2438-2442, 2021 Aug 17.
Artigo em Chinês | MEDLINE | ID: mdl-34399556

RESUMO

Objective: To investigate the factors related to myasthenic crisis (MC) in myasthenia gravis patients (MG) with oropharyngeal involvement during hospitalization. Methods: The clinical data of 99 MG patients with oropharyngeal involvement who were admitted to Beijing Tongren Hospital from 2018 to 2020 were retrospectively reviewed. There were 52 males and 47 females, aged 17-89 (55±15) years old, with a disease duration of 1-240 [10 (4, 36)] months. Multivariable logistic regression analysis was used to determine the factors associated with MC. Results: A total of 19 (19.19%) patients developed into MC during hospitalization. Multivariate logistic regression analysis showed that age of hospitalization ≥ 60 years old (OR=31.378, 95%CI: 3.868-254.557, P=0.001), type B and C thymoma (OR=29.175, 95%CI: 2.986-285.016, P=0.004), excess oropharyngeal secretions (OR=12.649, 95%CI: 2.057-77.783, P=0.006) and infections (OR=9.539, 95%CI: 1.345-67.645, P=0.024) were independently related to MC in MG patients with oropharyngeal involvement. Conclusions: Older age, malignant thymoma, excess oropharyngeal secretions and infection are independently related to MC in MG patients with oropharyngeal involvement during hospitalization. Therefore, great attention should be paid to this type of MG patients, and increased oropharyngeal secretions and various infections should be actively treated, so as to reduce the occurrence of MC.


Assuntos
Miastenia Gravis , Neoplasias do Timo , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Hospitalização , Humanos , Lactente , Masculino , Pessoa de Meia-Idade , Miastenia Gravis/complicações , Complicações Pós-Operatórias , Estudos Retrospectivos , Timectomia , Adulto Jovem
14.
ANZ J Surg ; 91(10): 2188-2191, 2021 10.
Artigo em Inglês | MEDLINE | ID: mdl-34405499

RESUMO

BACKGROUND: The subxiphoid single-port approach for thymectomy has several advantages compared with conventional lateral transthoracic approaches. However, perioperative outcomes of subxiphoid single-port thymectomy are still lacking. The objective of this study is to present our 6-year experience of subxiphoid single-port thymectomy, including our learning curve. METHODS: All consecutive 49 patients undergoing subxiphoid single-port thymectomy between August 2014 and September 2020 were reviewed retrospectively. RESULTS: We analyzed data of 49 patients (27 males and 22 females) with a median age of 58 years (range 49-68). Two patients presented postoperative complications. The conversion to a different approach was required in four cases. The median follow-up time was 17 months (range 3-35) and locoregional recurrence was observed in one patient. There were no intraoperative deaths and postoperative mortality. The operation time cumulative summation learning curve analysis revealed that the curves descended from the 24th case. CONCLUSIONS: The subxiphoid single-port approach for thymectomy is a safe and feasible modality with few complications.


Assuntos
Cirurgia Torácica Vídeoassistida , Timectomia , Idoso , Feminino , Humanos , Curva de Aprendizado , Masculino , Pessoa de Meia-Idade , Duração da Cirurgia , Estudos Retrospectivos
15.
Khirurgiia (Mosk) ; (8): 58-62, 2021.
Artigo em Russo | MEDLINE | ID: mdl-34363446

RESUMO

OBJECTIVE: To compare long-term outcomes of video-assisted thoracoscopic (VATS) and conventional open surgery in patients with early-stage (Masaoka stage I-II) thymic malignancies. MATERIAL AND METHODS. A: Retrospective study included patients after VATS and open thymectomy for the period 2000-2019. Long-term outcomes were analyzed. RESULTS: VATS thymectomy was performed in 53 (54.1%) patients, open thymectomy - in 45 (45.9%) cases. Median follow-up period was 66.9 months. Overall 5-year survival was 89.8% and 97% in the Open and VATS groups, respectively (p=0.076). Disease-free survival rates were 79.6% and 86.6% (p=0.279), respectively. There was no significant difference in cumulative incidence of recurrence (13.3% vs 7.5%, p=0.505). Age <50 years and tumor size >5 cm were the independent risk factors of recurrence. CONCLUSION: VATS thymectomy is an effective approach ensuring similar long-term outcomes in patients with early stages of thymic malignancies.


Assuntos
Timoma , Neoplasias do Timo , Humanos , Pessoa de Meia-Idade , Recidiva Local de Neoplasia/patologia , Estadiamento de Neoplasias , Estudos Retrospectivos , Cirurgia Torácica Vídeoassistida , Timectomia/efeitos adversos , Timoma/diagnóstico , Timoma/cirurgia , Neoplasias do Timo/diagnóstico , Neoplasias do Timo/cirurgia
16.
Turk J Pediatr ; 63(4): 721-726, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34449157

RESUMO

BACKGROUND: True thymic hyperplasia (TTH) is characterized as a distinct increase in both size and weight of thymus, which retains normal microscopic and immunohistochemical appearances. Massive true thymic hyperplasia (MTTH) is an extremely rare but significant subtype of TTH in pediatric ages due to its potentially serious consequences. It was reported that the age of cases with MTTH was predominantly between 1 and 15 years, while those before 1 year rarely occurred. By presenting the diagnosis and treatment process of our case as well as reviewing the related literature, we aimed to analyze the clinical characteristics of MTTH for patients younger than 1 year. CASE: A 3-month-old male infant was admitted to our department with a chief complaint of gradually increasing polypnea over 9 days, whose preoperative imaging examination showed a large intrathoracic soft tissue shadow predominantly on the right side. The percutaneous fine-needle biopsy guided by ultrasonography was performed to identify its diagnosis. However, proliferating lymphocytes and Hassall`s corpuscles were seen microscopically in the biopsy tissues, which were immunohistochemically positive for CD3, CD19, CD20, CD99, TdT, PCK and Ki67 ( > 90%). Due to the aggravating symptoms, a second operation with total thymectomy was carried out successfully for this infant, which confirmed the diagnosis of TTH again by both morphological study and immunohistochemical staining from the surgical specimen. CONCLUSIONS: By reviewing the literature, there were only 10 cases with MTTH reported between 1975 and 2020 for children aged < 1 year of life, together with our present one. In MTTH patient`s sex had an obviously male predominance (70%). Nine out of 10 presented initial symptoms or signs related to respiratory system and 6 patients showed respiratory distress. All patients were successfully treated by surgical thymectomy without any postoperative complications. The prognosis of MTTH was very successful.


Assuntos
Doenças Linfáticas , Hiperplasia do Timo , Adolescente , Biópsia por Agulha Fina , Criança , Pré-Escolar , Humanos , Lactente , Masculino , Prognóstico , Timectomia , Timo , Hiperplasia do Timo/diagnóstico , Hiperplasia do Timo/cirurgia
17.
Kyobu Geka ; 74(9): 717-719, 2021 Sep.
Artigo em Japonês | MEDLINE | ID: mdl-34446629

RESUMO

We report a case of ectopic cervical thymoma that was difficult to differentiate from thyroid tumor. A 69-year-old woman was referred to our hospital with a tumor on the left side of the neck. Fine-needle aspiration cytology could not establish the diagnosis and the surgery was then performed for diagnosis and treatment. Since the intraoperative pathological diagnosis was also inconclusive, thymectomy was performed because of the macroscopic finding suggesting close relation to the thymus. The final pathological diagnosis was type AB thymoma.


Assuntos
Timoma , Neoplasias do Timo , Neoplasias da Glândula Tireoide , Idoso , Biópsia por Agulha Fina , Feminino , Humanos , Timectomia , Timoma/diagnóstico por imagem , Timoma/cirurgia , Neoplasias do Timo/diagnóstico por imagem , Neoplasias do Timo/cirurgia , Neoplasias da Glândula Tireoide/diagnóstico por imagem , Neoplasias da Glândula Tireoide/cirurgia
18.
BMC Cancer ; 21(1): 847, 2021 Jul 22.
Artigo em Inglês | MEDLINE | ID: mdl-34294070

RESUMO

BACKGROUND: Hematological indicators and clinical characteristics play an important role in the evaluation of the progression and prognosis of thymic epithelial tumors. Therefore, we aimed to combine these potential indicators to establish a prognostic nomogram to determine the relapse-free survival (RFS) of patients with thymic epithelial tumors undergoing thymectomy. METHODS: This retrospective study was conducted on 156 patients who underwent thymectomy between May 2004 and August 2015. Cox regression analysis were performed to determine the potential indicators related to prognosis and combine these indicators to create a nomogram for visual prediction. The prognostic predictive ability of the nomogram was evaluated using the consistency index (C-index), receiver operating characteristic (ROC) curve, and risk stratification. Decision curve analysis was used to evaluate the net benefits of the model. RESULTS: Preoperative albumin levels, neutrophil-to-lymphocyte ratio (NLR), T stage, and WHO histologic types were included in the nomogram. In the training cohort, the nomogram showed well prognostic ability (C index: 0.902). Calibration curves for the relapse-free survival (RFS) were in good agreement with the standard lines in training and validation cohorts. CONCLUSIONS: Combining clinical and hematologic factors, the nomogram performed well in predicting the prognosis and the relapse-free survival of this patient population. And it has potential to identify high-risk patients at an early stage. This is a relatively novel approach for the prediction of RFS in this patient population.


Assuntos
Neoplasias Epiteliais e Glandulares/mortalidade , Neoplasias do Timo/mortalidade , Adulto , Idoso , Biomarcadores , Gerenciamento Clínico , Feminino , Seguimentos , Humanos , Contagem de Leucócitos , Linfócitos , Masculino , Pessoa de Meia-Idade , Gradação de Tumores , Estadiamento de Neoplasias , Neoplasias Epiteliais e Glandulares/diagnóstico , Neoplasias Epiteliais e Glandulares/cirurgia , Neutrófilos , Nomogramas , Prognóstico , Curva ROC , Estudos Retrospectivos , Timectomia/métodos , Neoplasias do Timo/diagnóstico , Neoplasias do Timo/cirurgia , Resultado do Tratamento
19.
Eur J Cardiothorac Surg ; 60(4): 890-895, 2021 10 22.
Artigo em Inglês | MEDLINE | ID: mdl-34263301

RESUMO

OBJECTIVES: The goal of this study was to analyse the outcomes in 53 patients with thymoma, 34 of whom had myasthenia gravis (MG), who were treated with robotic surgery. The oncological outcomes of the whole series of patients were analysed. Furthermore, because consistent data are not yet available in the literature, the main focus was the analysis of the neurological results of the patients affected by MG and thymoma. METHODS: The clinical outcomes of 53 patients with a diagnosis of thymoma who underwent robotic thymectomy between January 2014 and December 2019 in our institution were collected and evaluated; 34 of these patients had a concomitant diagnosis of MG. The neurological status of the patients was determined from a clinical evaluation according to the Osserman classification and on pre- and post-surgery Myasthenia Gravis Composite scores, whereas neurological clinical outcomes were assessed using the Myasthenia Gravis Foundation of America Post-Intervention Score. Reduction of steroid therapy was also considered. The recurrence rate, adjuvant radiotherapy and overall survival of the patients with a thymoma were evaluated. RESULTS: Neurological outcomes: improvement of the clinical conditions was obtained in 26 patients (76.5%) following the operation: complete stable remission was observed in 5 patients (14.7%), pharmacological remission in 10 (29.4%) and minimal manifestation in 11 (32.3%). Four patients (11.8%) exhibited no substantial change from the pretreatment clinical manifestations or reduction in MG medication and 4 (11.8%) patients experienced worsening of clinical conditions. In 21 patients (61.7%) a reduction of the dosage of steroid therapy was obtained. Oncological outcomes: at an average follow-up of 36 months, the overall survival was 96%, 4 patients (7.5%) had pleural relapses and 12 patients (22.6%) underwent postoperative radiotherapy, according to their stage. In accordance with Masaoka staging, 34% were in stage I, 56.6% in stage II and 9.4% in stage III. CONCLUSIONS: Our results suggest that robotic surgical treatment of patients with thymoma and concomitant MG is effective in improving the neurological outcomes. Moreover, the oncological results obtained in this series confirm the efficacy of robotic surgery for the treatment of thymic malignancies, with results in line with those of open surgery. However, due to the indolent growth of thymomas, further observations with longer follow-up are necessary.


Assuntos
Miastenia Gravis , Procedimentos Cirúrgicos Robóticos , Timoma , Neoplasias do Timo , Humanos , Miastenia Gravis/complicações , Miastenia Gravis/cirurgia , Recidiva Local de Neoplasia , Estudos Retrospectivos , Procedimentos Cirúrgicos Robóticos/efeitos adversos , Timectomia , Timoma/complicações , Timoma/cirurgia , Neoplasias do Timo/complicações , Neoplasias do Timo/cirurgia , Resultado do Tratamento
20.
Khirurgiia (Mosk) ; (7): 31-35, 2021.
Artigo em Russo | MEDLINE | ID: mdl-34270191

RESUMO

OBJECTIVE: To improve the short-term postoperative outcomes in patients with thymoma stage I-II by using of thoracoscopic thymectomy (VATS TE) and to compare this technique with open (OTE) thymectomy. MATERIAL AND METHODS: A retrospective analysis included 98 patients who had undergone surgery for thymoma stage I and II for the period from January 2001 to December 2019. VATS TE (main group) was performed in 53 (54.1%) cases, OTE (control group) - in 45 (45.9%) patients. RESULTS: Duration of VATS TE and OTE was similar. VATS procedure was characterized by less intraoperative blood loss (50 vs 225 ml, p=0.000), lower pain scores and morphine consumption (p=0.000), shorter postoperative pleural drainage (1.5 vs 3.8 days, p=0.000), and postoperative hospital-stay (7.6 vs 12.7 days, p=0.000). Incidence of major complications was significantly less in the main group (9.4% vs. 1.9%, p=0.001). CONCLUSION: VATS TE is effective and safe procedure for thymoma stage I-II. Postoperative period after VATS TE is characterized by less intraoperative blood loss, incidence of complications, duration of pleural drainage and hospital-stay.


Assuntos
Timoma , Neoplasias do Timo , Humanos , Estadiamento de Neoplasias , Estudos Retrospectivos , Cirurgia Torácica Vídeoassistida , Timectomia/efeitos adversos , Timoma/diagnóstico , Timoma/cirurgia , Neoplasias do Timo/diagnóstico , Neoplasias do Timo/cirurgia , Resultado do Tratamento
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