Efficacy and safety of thoracoscopic thymectomy in the treatment of juvenile myasthenia gravis

Christison‐Lagay, Emily R.; Dharia, Bela; Vajsar, Jiri; Kim, Peter C.

doi:10.1007/s00383-013-3284-x

Cited by 20 publications

(21 citation statements)

References 9 publications

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“…Studies in the JMG population are far less robust, though multiple retrospective analyses have shown both open and minimally invasive approaches to be safe and effective in children [ 17 , 18 , 22 ]. Thoracoscopic series are fewer in number, but suggest benefits of decreased estimated blood loss, shorter hospital stays, and improved cosmesis [ 23 , 24 ]. Madenci et al in 2017 published a systematic review of the literature from 2000 to 2016 regarding thymectomy for the treatment of JMG [ 14 ].…”

Section: Discussionmentioning

confidence: 99%

“…Despite the increased sample size, our study is insufficiently powered for statistical demonstration of remission, defined by the MGFA as “no symptoms or signs of MG for at least 1 year and… no therapy for MG during that time” [ 20 ]. Remission patterns in JMG have been shown to wax and wane, significantly affected by external stressors and illness, but with an overall trend towards greater improvement further out from surgery [ 23 , 25 ]. Longitudinal follow-up of this population will be required to determine true effectiveness of operative intervention here.…”

Section: Discussionmentioning

confidence: 99%

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Thoracoscopic thymectomy for juvenile myasthenia gravis

et al. 2019

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Purpose A randomized controlled trial of thymectomy in myasthenia gravis demonstrated improved clinical outcomes in adults, but data surrounding juvenile cases, especially those treated with minimally invasive approaches, are limited. Here, we review our experience with thoracoscopic thymectomy for juvenile myasthenia gravis (JMG) in the largest cohort to date. Methods All cases of thymectomy for JMG in a single tertiary referral center between 2007 and 2018 were reviewed ( N = 50). Patients underwent left thoracoscopic approach with extended dissection and without use of monopolar energy. Demographics, diagnostic criteria, and clinical classification, as well as surgical data were collected. Clinical status and medications were reviewed in follow-up. Results The mean age at surgery was 10.5 ± 0.8 years. Ocular disease and generalized disease each comprised half of the cohort. No patients suffered complications or increased risk of morbidity or mortality with thymectomy. At any interval of follow-up through 3.5 years, 49.8% of patients were improved compared to their pre-operative presentation, and there was a significant trend towards decreased steroid use. Conclusion Thoracoscopic thymectomy is a safe treatment for juvenile myasthenia gravis in pediatric patients over a wide range of ages, body masses, and symptoms. Our experience adds evidence that pediatric patients likely benefit from thymectomy with improved clinical status and reduced medications.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Thoracoscopic thymectomy for juvenile myasthenia gravis

et al. 2019

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“…The postoperative stay was shorter (mean 2.9 days) compared with previously cited in the literature on the open sternal procedure (mean: 8-17 days), 9,27 thus making it comparable to the thoracoscopic thymectomy group (mean: 1.5-2.6 days). [9][10][11]13 The point of diagnosis is delayed with a mean time of 8.8 months after symptom onset in our group. The question is whether an early diagnosis and early appropriate pharmacological therapy may lead to a better outcome-we have no evidence that in patients who were diagnosed early in the course of the diseases the severity of symptoms or the amount of pharmacological therapy were at a lower level (see ►Tables 1 and 2).…”

Section: Discussionmentioning

confidence: 61%

“…4 In few recent studies including 49 children, thoracoscopic thymectomy was also safe for children with JMG. [9][10][11][12][13] At present, there is only one report on the safety of roboticassisted thymectomy in nine children with JMG; 14 randomized control studies for robotic-assisted thymectomy are missing.…”

Section: Introductionmentioning

confidence: 99%

Outcome after Robotic-Assisted Thymectomy in Children and Adolescents with Acetylcholine Receptor Antibody-Positive Juvenile Myasthenia Gravis

et al. 2017

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The aim of our study was to describe the long-term outcomes after robotic-assisted thymectomy in a cohort of acetylcholine receptor (AChR)-antibody (Ab)–positive, generalized juvenile myasthenia gravis (JMG). We retrospectively analyzed a cohort of 18 patients (15 females and 3 males) who underwent robotic-assisted thymectomy. At the time of diagnosis, 12/18 patients were prepubertal; the mean age was 9.8 years at the onset of the disease. All patients received therapy with pyridostigmine; additional immunotherapy included: corticosteroid therapy in 18/18, azathioprine in 14/18 patients, mycophenolate mofetil in 4/18, and cyclosporine in 1/18 patients. Eight patients received intravenous immunoglobulin and four plasma exchange. The mean age of patients at thymectomy was 11.7 years (range: 4.2–16 years). The mean duration of postoperative stay was 2.9 days. Thymectomy was followed by gradual clinical improvement (39% patients achieved clinical remission) and dose reduction in steroid therapy in all patients during the follow-up period (mean: 27.4 months). In children and adolescents with AChR-Ab–positive JMG, thymectomy has a beneficial effect on the weaning off immunosuppressive therapy in patients with generalized symptoms and should be considered as a part of multimodal therapy. Robotic-assisted thymectomy is a safe procedure with low morbidity and a comparable clinical outcome compared with the open sternal procedure.

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“…In one series, thoracoscopic thymectomy was managed without muscle relaxation in 20 children [35], whereby endotracheal intubation was achieved with a single lumen tube, which does not necessitate a deep muscle relaxation. On the other hand, the benefits and necessities of lung isolation should also be considered.…”

Section: Juvenile Myasthenia Gravismentioning

confidence: 99%