Minimal Access Surgery for Thymoma

Kumar, Arvind; Asaf, Belal Bin; Pulle, Mohan Venkatesh; Puri, Harsh Vardhan; Bishnoi, Sukhram; Gopinath, Srinivas Kodaganur

doi:10.1007/s13193-020-01208-1

Cited by 3 publications

(5 citation statements)

References 61 publications

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“…Less tissue is removed during the trans-cervical technique since it only requires a thin horizontal incision across the back of the patient's neck. In a systematic analysis of the long-term clinical result following trans-cervical thymectomy supports a shorter recovery time [26] .…”

Section: Trans-sternal Thymectomy Vs Video Assisted Thoracoscopic Sur...mentioning

confidence: 93%

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An Overview of Thymectomy Approaches among Myasthenia Graves Patients: Review Article

Desoky¹,

Emam²,

Ragab³

et al. 2023

The Egyptian Journal of Hospital Medicine

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Background: Myasthenia gravis (MG) is a syndrome characterized by fatigue-and activity-induced improvements in skeletal muscular weakening. There is a wide range of possible involvement, including but not limited to the muscles of the eyes, face, oropharynx, trunk, and limbs. Once the patient's level of weakness has been managed to the point that surgery is possible, thymectomy is recommended. Preoperatively, patients are typically treated with mild doses of intravenous immunoglobulins as well as glucocorticoids. Objective: Review of the literature on thymectomy approaches among myasthenia graves' patients. Methods: We scoured medical journals and databases including PubMed, Google Scholar, and Science Direct for information on thymectomy and myasthenia graves. Between September 2006 and August 2022, however, only the latest or most comprehensive study was considered. The authors also assessed the usefulness of references drawn from similar books. Documents written in languages other than English have been overlooked because of lack of funding to translate them. Unpublished articles, oral talks, conference abstracts, and dissertations were all generally agreed upon not to constitute valid scientific investigation. Conclusion: It has been argued that a maximum thymectomy, in which both the transsternal and transcervical techniques are used on the same MG patient, yields superior results. After extensive transsternal thymectomy or video-assisted thoracoscopic thymectomy, half of patients with non-thymomatous MG had complete stable remissions at 6 years of follow-up.

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Section: Trans-sternal Thymectomy Vs Video Assisted Thoracoscopic Sur...mentioning

confidence: 93%

“…Since the superior vena cava is located outside of the operating field, it was recommended that dissection operations are safer when performed from the left side. According to the authors, it is easier to access the peri-thymic fatty tissue around the left peri-cardiophrenic angle if you start on the left [26] .…”

Section: Vats Thymectomy Approachesmentioning

confidence: 99%

An Overview of Thymectomy Approaches among Myasthenia Graves Patients: Review Article

Desoky¹,

Emam²,

Ragab³

et al. 2023

The Egyptian Journal of Hospital Medicine

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“…Thymectomy by video-thoracoscopy (VATS) is necessarily performed under general anesthesia. To achieve this, first of all, selective endotracheal intubation is necessary [ 88 ].…”

Section: Vats Thymectomymentioning

confidence: 99%

Thymus Surgery Prospectives and Perspectives in Myasthenia Gravis

Salahoru,

Grigorescu,

Hinganu

et al. 2024

JPM

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The thymus is a lymphoid organ involved in the differentiation of T cells, and has a central role in the physiopathogenesis of Myasthenia Gravis (MG). This connection is proved by a series of changes in the level of neuromuscular junctions, which leads to a decrease in the amplitude of the action potential in the post-synaptic membrane. Because of this, the presence of anti-cholinergic receptor antibodies (AChR), characteristic of MG, is found, which causes the progressive regression of the effect of acetylcholine at the level of neuromuscular junctions, with the appearance of muscle weakness. The thymectomy is a surgical variant of drug therapy administered to patients with MG. In the case of patients with nonthymomatous MG, thymectomy has become a therapeutic standard, despite the fact that there is no solid scientific evidence to explain its positive effect. Videothoracoscopic surgery or robotic surgery led to a decrease in the length of hospital stay for these patients. This paper aims to synthesize the information presented in the literature in order to create a background for the perspectives of thymectomy.

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“…[6][7][8] While National Comprehensive Cancer Network guidelines recommend oncologic resection, in practice large thymoma (>4 cm) resections are typically performed via an open approach due to increased complexity associated with minimally invasive approaches for larger tumors. 9,10 Opponents of thoracoscopic approaches to thymectomy support the use of minimally invasive approaches for mediastinal mass resections only in small tumors, benign masses, and for diagnostic purposes. 2 On the other hand, some studies have shown promise in both safety and efficacy for minimally invasive approaches to resections of large tumors via VATS.…”

Section: Introductionmentioning

confidence: 99%

“…6-8 While National Comprehensive Cancer Network guidelines recommend oncologic resection, in practice large thymoma (>4 cm) resections are typically performed via an open approach due to increased complexity associated with minimally invasive approaches for larger tumors. 9,10…”

Section: Introductionmentioning

confidence: 99%

Is Minimally Invasive Resection of Large Thymoma Appropriate?

Manyak,

Bassiri,

Alvarado

et al. 2024

The American Surgeon™

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Background Current practice patterns suggest open rather than minimally invasive (MIS) approaches for thymomas >4 cm. We hypothesized there would be similar perioperative outcomes and overall survival between open and MIS approaches for large (>4 cm) thymoma resection. Methods The National Cancer Database was queried for patients who underwent thymectomy from 2010 to 2020. Surgical approach was characterized as either open or MIS. The primary outcome was overall survival and secondary outcomes were margin status, and length of stay (LOS). Differences between approach cohorts were compared after a 1:1 propensity match. Results Among 4121 thymectomies, 2474 (60%) were open and 1647 (40%) were MIS. Patients undergoing MIS were older, had fewer comorbidities, and had smaller tumors (median; 4.6 vs 6 cm, P < .001). In the unmatched cohort, MIS and open had similar 90-day mortality (1.1% vs 1.8%, P = .158) and rate of positive margin (25.1% vs 27.9%, P = .109). MIS thymectomy was associated with shorter LOS (2 (1-4) vs 4 (3-6) days, P < .001). Propensity matching reduced the bias between the groups. In this cohort, overall survival was similar between the groups by log-rank test ( P = .462) and multivariate cox hazard analysis (HR .882, P = .472). Multivariable regression showed shorter LOS with MIS approach (Coef −1.139, P < .001), and similar odds of positive margin (OR 1.130, P = .150). Discussion MIS has equivalent oncologic benefit to open resection for large thymomas, but is associated with shorter LOS. When clinically appropriate, MIS thymectomy may be considered a safe alternative to open resection for large thymomas.

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Minimal Access Surgery for Thymoma

Cited by 3 publications

References 61 publications

An Overview of Thymectomy Approaches among Myasthenia Graves Patients: Review Article

An Overview of Thymectomy Approaches among Myasthenia Graves Patients: Review Article

Thymus Surgery Prospectives and Perspectives in Myasthenia Gravis

Is Minimally Invasive Resection of Large Thymoma Appropriate?

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