Myasthenia is a poor prognostic factor for perioperative outcomes after robotic thymectomy for thymoma

Kumar, Arvind; Asaf, Belal Bin; Pulle, Mohan Venkatesh; Puri, Harsh Vardhan; Sethi, Nitin; Bishnoi, Sukhram

doi:10.1093/ejcts/ezaa406

Cited by 7 publications

(7 citation statements)

References 27 publications

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“…In our opinion, the extensive presurgical and perioperative care for myasthenic thymoma patients at the MUMCþ led to a lower number of myasthenic complications and deaths than has previously been reported. 18,19 The 5-year thymoma-related survival rate in this study was 96.6%. Although the survival rate is commonly high with thymomas in comparison with other oncologic tumors, high morbidity due to paraneoplastic syndromes and recurrences is common.…”

Section: Resultsmentioning

confidence: 52%

Robotic Thymectomy for Thymomas: A Retrospective Follow-up Study in the Netherlands

Marcuse¹,

Hochstenbag²,

Baets³

et al. 2022

The Annals of Thoracic Surgery

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BACKGROUND The Maastricht University Medical CenterD is a Dutch center of expertise appointed by the Netherlands Federation of University Medical Centers for the treatment of thymomas. The aim of this study was to investigate the long-term oncologic, surgical, and neurologic outcomes of all patients who underwent a robotic thymectomy for a thymoma at Maastricht University Medical CenterD.METHODS We retrospectively analyzed the clinical-pathologic data of all consecutive patients with a thymoma who underwent robotic thymectomy using the DaVinci robotic system at Maastricht University Medical CenterD between April 2004 and December 2018. Follow-up data were collected from 60 referring Dutch hospitals. RESULTSIn total, 398 robotic thymectomies were performed, and 130 thymomas (32.7%) were found. Median followup time was 46 months; median procedure time, 116 minutes; and median hospitalization time, 3 days. In 8.4% of patients, a conversion was performed, and in 20.8%, a complication was registered. The majority of myasthenic patients with a thymoma went into remission, mostly within 12 to 24 months after thymectomy (81%). No statistical difference was found in the number of complications, conversions, incomplete resections, or deaths between patients with myasthenia gravis and nonmyasthenic patients. Thirty-six patients (27.7%) underwent postoperative radiotherapy. The recurrence rate was 9.1%, and the 5-year thymoma-related survival rate was 96.6%.CONCLUSIONS Robotic thymectomy was found to be safe and feasible for early stage thymomas, most advancedstage thymomas, and thymomatous myasthenia gravis. A national guideline could contribute to the improvement of the oncologic follow-up of thymic epithelial tumors in the Netherlands.

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Section: Resultsmentioning

confidence: 52%

Robotic Thymectomy for Thymomas: A Retrospective Follow-up Study in the Netherlands

Marcuse¹,

Hochstenbag²,

Baets³

et al. 2022

The Annals of Thoracic Surgery

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“…Although non‐significant, we recorded a mild trend of stage IVa complications in patients with preoperative symptomatic myasthenia. In keeping with these observations, Kumar [27] found a significant higher incidence of PC in myasthenia patients compared to non‐myasthenic in a series of thymoma operated on via robotic technique.…”

Section: Commentmentioning

confidence: 67%

Early Postoperative Results after Thymectomy for Thymic Cancer: A Single‐Institution Experience

et al. 2023

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Background Surgery for thymic cancers is considered the key of curative treatment. Preoperative patients’ characteristics and intraoperative features might influence postoperative outcome. We aim to verify short-term outcomes and possible risk factors for complications after thymectomy. Methods We retrospectively investigated patients undergoing surgery for thymoma or thymic carcinoma in the period between January 1, 2008, and December 31, 2021, in our department. Preoperative features, surgical technique (open, bilateral VATS, RATS), intraoperative characteristics and incidence of postoperative complications (PC) were analyzed. Results We included in the study 138 patients. Open surgery was performed in 76 patients (55.1%), in 36 VATS (26.1%) and in 26 RATS (36.1%). Resection of one or more adjacent organs due to neoplastic infiltration was required in 25 patients. PC appeared in 25 patients (52% Clavien–Dindo grade I, 12% grade IVa). Open surgery had a higher incidence of PC (p < 0.001), longer postoperative in-hospital stay (p = 0.045) and larger neoplasm (p = 0.006). PC were significant related to pulmonary resection (p = 0.006), phrenic nerve resection (p = 0.029), resection of more than one organ (p = 0.009) and open surgery (p = 0.001), but only extended surgery of more organs was confirmed as independent prognostic factor for PC (p = 0.0013). Patients with preoperative myasthenia symptoms have a trend toward stage IVa complications (p = 0.065). No differences were observed between outcomes of VATS and RATS. Conclusions Extended resections are related to a higher incidence of PC, while VATS and RATS guarantee a lower incidence of PC and shorter postoperative stay even in patients that require extended resections. Symptomatic myasthenia patients might have a higher risk toward more severe complications.

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“…Although both lateral and subxiphoid approaches have been reported [ 7 , 8 , 9 , 10 , 11 , 12 , 14 , 28 , 31 , 32 , 33 , 34 ], it is unclear which approach is better during robotic thymectomy. We compared the surgical outcomes and factors contributing to low surgical invasiveness associated with these approaches.…”

Section: Anterior Mediastinal Tumormentioning

confidence: 99%

Robotic Mediastinal Tumor Resections: Position and Port Placement

Okazaki

Shien

Suzawa

et al. 2022

JPM

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This study aimed to determine the optimal position and port placement during robotic resection for various mediastinal tumors. For anterior mediastinal tumors, total or extended thymectomy is commonly performed in the supine position using the lateral or subxiphoid approach. Although it is unclear which approach is better during robotic thymectomy, technical advantages of subxiphoid approach are beneficial for patients with myasthenia who require extended thymectomy. Partial thymectomy is performed in the supine position using a lateral approach. Superior, middle, and posterior mediastinal tumors are resected in the decubitus position using the lateral approach, whereas dumbbell tumor resection, which requires a posterior approach, can be performed in the prone position. The position and port placement should be chosen depending on the size, location, and aggressiveness of the tumor. In this study, we describe how to choose which of these different robotic approaches can be used based on our experience and previous reports.

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Myasthenia is a poor prognostic factor for perioperative outcomes after robotic thymectomy for thymoma

Cited by 7 publications

References 27 publications

Robotic Thymectomy for Thymomas: A Retrospective Follow-up Study in the Netherlands

Robotic Thymectomy for Thymomas: A Retrospective Follow-up Study in the Netherlands

Early Postoperative Results after Thymectomy for Thymic Cancer: A Single‐Institution Experience

Robotic Mediastinal Tumor Resections: Position and Port Placement

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