Randomized trial of thymectomy in myasthenia gravis

Wolfe, Gil I.; Kaminski, Henry J.; Sonnett, Joshua; Aban, Inmaculada; Kuo, Hui-Chien; Cutter, Gary

doi:10.21037/jtd.2016.12.80

Cited by 122 publications

(185 citation statements)

References 11 publications

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“…We appreciate the wide interest in the results from the international extended transsternal thymectomy trial in non-thymomatous myasthenia gravis (MG) (1). Correspondence has been received from several medical communities including neurologists, thoracic surgeons, and pathologists.…”

Section: To the Editormentioning

confidence: 99%

Randomized Trial of Thymectomy in Myasthenia Gravis

2016

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Section: To the Editormentioning

confidence: 99%

Randomized Trial of Thymectomy in Myasthenia Gravis

2016

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“…This indication was recently confirmed in a randomized clinical trial comparing extended transsternal thymectomy and standard clinical treatment; better outcomes were observed in 3-year followup in the surgical group (2). Similarly, to what happened with thymic malignancies, many surgeons had the perception that MIS for thymectomy in myasthenic patients would result in an incomplete procedure.…”

Section: Introductionmentioning

confidence: 83%

Thymic minimally invasive surgery: state of the art across the world: Central-South America

Terra

2017

J. Vis. Surg.

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Literature suggests that, for thymectomy in myasthenia or resection of thymic tumors, minimally invasive surgery is equivalent to open surgery with regard to long-term outcomes. However, it could bring some benefits in the immediate results as complication rate or length-of-stay. There are doubts about the worldwide adoption of the method, though. In Latin America, the implementation of video-assisted thoracic surgery (VATS) started in the 1990s, but it progressed slowly. The main barriers were associated costs and training. Thymic surgery poses a bigger challenge due to its rarity, so just a few reports mention the use of the method in the region. Nonetheless, in recent years we observe a faster dissemination of the method both in number and in complexity of the procedures performed. Confirming this fact, half of the patients registered in the Brazilian Society of Thoracic Surgery database in the last 2 years as undergoing resection of thymic tumors, underwent a minimally invasive procedure. Although promising, robotic surgery is still in its early days in Latin America.

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“…It has been reported that remission and recovery rates of MG in patients with thymoma are similar or slightly worse than those without thymoma [10]. Non-thymomatous MG (anti-AChR antibody-positive) In the absence of thymoma, thymectomy is generally thought to be beneficial to generalize MG and AChR antibodies-positive patients [11][12][13]. Appropriate age for surgery, stage in which surgery will be performed during the course of the disease, surgery approach type, role of thymectomy in ocular MG, seronegative MG, and MuSK antibodies-associated MG cases are still questions to be answered.…”

Section: Thymomatous Mgmentioning

confidence: 99%

“…In 2016, Wolfe et al [13] (MGTX Study Group) report the results of a randomized, controlled trial comparing the effects of thymectomy and prednisone therapy versus prednisone therapy alone. The results supported the benefit of thymectomy in patients with non-thymomatous MG.…”

Section: Efficiency Of Thymectomymentioning

confidence: 99%

Thymectomy in Myasthenia Gravis

Aydın¹,

Ulaş²,

Mutlu³

et al. 2017

Eurasian J Med

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In recent years, thymectomy has become a widespread procedure in the treatment of myasthenia gravis (MG). Likelihood of remission was highest in preoperative mild disease classification (Osserman classification 1, 2A). In absence of thymoma or hyperplasia, there was no relationship between age and gender in remission with thymectomy. In MG treatment, randomized trials that compare conservative treatment with thymectomy have started, recently. As with non-randomized trials, remission with thymectomy in MG treatment was better than conservative treatment with only medication. There are four major methods for the surgical approach: transcervical, minimally invasive, transsternal, and combined transcervical transsternal thymectomy. Transsternal approach with thymectomy is the accepted standard surgical approach for many years. In recent years, the incidence of thymectomy has been increasing with minimally invasive techniques using thoracoscopic and robotic methods. There are not any randomized, controlled studies which are comparing surgical techniques. However, when comparing non-randomized trials, it is seen that minimally invasive thymectomy approaches give similar results to more aggressive approaches.Keywords: Extended thymectomy, follow-up, myasthenia gravis, thoracoscopic thymectomy ÖZ Miyastenia gravis tedavisinde son yıllarda timektomi giderek yaygınlaşan bir prosedür haline geldi. Preoperatif hafif hastalık sınıflaması (Osserman sınıflaması 1, 2A) olanlarda remisyon ihtimali en yüksek olarak gösterildi. Timoma veya hiperplazi yokluğunda timektomi ile remisyon sağlamada yaş ve cinsiyetin ilişkisi gösterilemedi. Miyastenia gravis tedavisinde timektomi ile konservatif tedaviyi karşılatıran randomize çalışmalar yeni yayınlanmaya başlandı. Nonrandomize çalışmalarda olduğu gibi Miyastenia gravis tedavisinde timektomi ile remisyon, sadece ilaçla konservatif tedaviden daha iyi bulundu. Cerrahi yaklaşım için transservikal, minimal invaziv, transsternal ve kombine transservikal transsternal timektomi olmak üzere dört major yöntem bulunmaktadır. Transsternal yaklaşımla timektomi yıllardır kabul gören standart cerrahi yaklaşımdır. Son yıllarda torakoskopik ve robotik yöntemin kullanıldığı minimal invaziv tekniklerle timektomi sıklığı artmaktadır. Cerrahi teknikleri karşılaştıran randomize, kontrollü çalışmalar bulunmamaktadır. Ancak nonrandimize çalışmalar arasındaki karşılaştırmalara bakıldığında minimal invaziv timektomi yaklaşımlarının daha agresif yaklaşımlara benzer sonuçlar verdiği görülmektedir.

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Randomized trial of thymectomy in myasthenia gravis

Cited by 122 publications

References 11 publications

Randomized Trial of Thymectomy in Myasthenia Gravis

Randomized Trial of Thymectomy in Myasthenia Gravis

Thymic minimally invasive surgery: state of the art across the world: Central-South America

Thymectomy in Myasthenia Gravis

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