Perioperative management in myasthenia gravis: republication of a systematic review and a proposal by the guideline committee of the Japanese Association for Chest Surgery 2014

Kadota, Yoshihisa; Horio, Hirotoshi; Mori, Takeshi; Sawabata, Noriyoshi; Goto, Taichiro; Yamashita, Shinichi; Nagayasu, Takeshi; Iwasaki, Atsushi

doi:10.1007/s11748-015-0518-y

Cited by 11 publications

(11 citation statements)

References 135 publications

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“…Four major surgical approaches are used: In all of these procedures, the thymus is resected, but the resection of extracapsular mediastinal and cervical fat tissue varies. There is no persuasive evidence of superior efficacy or long-term remission rates in MG for either of these approaches [18].…”

Section: Surgical Methodsmentioning

confidence: 99%

“…Guillermo et al [17] reported that AChR antibody-positive and -negative cases have similar response rates at least 3 years follow-up, in a retrospective cohort study. Similar to anti-AChR-positive MG, generalized MG has been reported to have a double-seronegative MG as an indication for thymectomy [18].…”

Section: Seronegative Myastheniamentioning

confidence: 96%

“…In some clinics, it is recommended as a treatment option with less invasive procedures. No significant indications for thymectomy have been shown in patients with ocular-type double-seronegative MG as well as in ocular-type anti-AChR antibodyassociated cases [18].…”

Section: Ocular Myastheniamentioning

confidence: 99%

“…Mortality rates associated with thymectomy are ≤1% even in cases with insufficiently controlled MG symptoms [14]. Complications related to thymectomy include crisis (6%), infections (11%), and recurrent laryngeal nerve / phrenic nerve injury (2%) [18].…”

Section: Adverse Effects Of Thymectomymentioning

confidence: 99%

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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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Section: Surgical Methodsmentioning

confidence: 99%

Section: Seronegative Myastheniamentioning

confidence: 96%

Section: Ocular Myastheniamentioning

confidence: 99%

Section: Adverse Effects Of Thymectomymentioning

confidence: 99%

See 2 more Smart Citations

Thymectomy in Myasthenia Gravis

Aydın¹,

Ulaş²,

Mutlu³

et al. 2017

Eurasian J Med

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“…International consensus and guidelines recommend all MG patients with resectable thymoma undergo thymectomy after MG is well controlled, and thymectomy is performed for the treatment of thymoma with the resection of thymus and the mediastinal and lower cervical fat (22,28,37). Although many studies have shown robotic thymectomy is safe and feasible for MG patients with early-stage thymoma, the proper size of thymoma for robotic thymectomy and the long-term oncologic outcome after robotic thymectomy are still under debate (38)(39)(40).…”

Section: Tips Tricks and Pitfallsmentioning

confidence: 99%

Complete thymectomy for myasthenia gravis

Rückert¹,

Zhang²,

Li³

et al. 2021

J Vis Surg

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The therapeutic value of transsternal extended thymectomy for patients with myasthenia gravis (MG) has been determined by the results of the Myasthenia Gravis Thymectomy Trial (MGTX). The most crucial point of thymectomy lies in the completeness of the resection with the thymus, mediastinal fat, lower cervical fat and thymoma (if any), the more complete the resection the better neurological outcome.In clinical practice, the minimally invasive approaches for thymectomy have become a "usual" approach for thymectomy in many centers worldwide. Robotic thymectomy, as the latest advance in minimally invasive thymectomy, has gained much popularity and has been regarded as a promising approach for MG patients with encouraging neurological outcomes. Although several approaches for robotic thymectomy have been described, the authors recommend a unilateral approach from the left side with 3 trocars only for most of the cases, this is for several anatomical reasons, e.g., access to the common anatomical locations with ectopic thymic tissues; dissection of the upper poles and thymic veins; atypical anatomy of the left thymic main lobe, visualization of the contralateral phrenic nerve favor this technique. Herein, the authors describe the left-sided robotic extended thymectomy for MG patients in detail including patient selection and workup, preoperative preparation, equipment preference cart, procedure and tips, tricks and pitfalls.

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