Subxiphoid-subcostal thoracoscopic thymectomy for seropositive myasthenia offers equivalent remission rates and potentially faster recovery

Cao, Pei; Huang, Shan; Qu, Wensheng; Kong, Kangle; Han, Peng; Yue, Jiaqi; Deng, Yu; Fu, Xiangning; Фан, Ли; Zhao, Bo

doi:10.1093/icvts/ivab294

Cited by 12 publications

(9 citation statements)

References 28 publications

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“…After a 5-10 case learning curve, only patients with extensive invasion required conversion to an open sternotomy. The mean operative time in the subxiphoid group was 98 min, similar to other studies (13,18,21,22) with a range of 95-147 min. The blood loss in our study was 29.2 ml, which was also similar to their results, with a range of 25.5-73.8 ml.…”

Section: Discussionsupporting

confidence: 88%

“…Several studies have confirmed the safety of the subxiphoid approach when applied to anterior mediastinal lesions ( 18 , 20 , 21 ). The approach via subxiphoid and subcostal arches was adopted in our center in 2017.…”

Section: Discussionmentioning

confidence: 90%

“…Furthermore, a comparison of the perioperative and follow-up outcomes of patients with MG who underwent subxiphoid-subcostal or unilateral thoracoscopic thymectomy showed that only pain scores were significantly lower in the subxiphoid group postoperatively. However, the myasthenia crisis was less frequent, and the neurological results were better ( 21 , 22 ).…”

Section: Discussionmentioning

confidence: 99%

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Neurological outcomes of extended thymectomy for thymomatous myasthenia gravis: Subxiphoid vs. trans-sternal approaches

et al. 2022

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BackgroundThe subxiphoid approach has been widely used recently. However, there is little data focusing on neurological outcomes in patients with thymomatous myasthenia gravis (MG) who underwent subxiphoid thoracoscopic thymectomy. The purpose of this study was to compare the neurological outcomes of patients with thymomatous MG who underwent extended thymectomy with a subxiphoid or transthoracic approach 1 year postoperatively.MethodsThe records of patients with Masaoka stage I and II thymomas who underwent extended thymectomy from January 2019 to December 2020 with tumor size less than 5 cm and thymomatous MG were retrospectively reviewed and evaluated. Neurological outcomes were measured by a quantitative myasthenia gravis score (QMGS), with a 2.3-point reduction in QMGS associated with improvement in clinical MG status. The clinical efficacy and variables affecting the outcomes were assessed using the Kaplan–Meier method and Cox proportional hazard regression analysis.ResultsA total of 89 patients were included in the analysis, of which 44 had a subxiphoid approach and 45 had a trans-sternal approach. Mean QMGS decreased from 12 at initial diagnosis to 8.7 preoperatively and 5.6 at 12 months postoperatively in the subxiphoid group and from 12.1 to 8.9 to 6.0 in the transthoracic group. Thirteen patients (28.9%) who underwent the trans-sternal approach and 10 (22.7%) who underwent the subxiphoid approach did not have an improved clinical status compared with their preoperative status. The median time to clinical improvement was 3 months (95% CI, 2.15–3.85) for the subxiphoid approach and 6 months (95% CI, 5.54–6.46) for the trans-sternal approach. Univariate results showed that the subxiphoid approach was associated with a faster improvement in clinical status (HR = 1.701, 95% CI, 1.044–2.773, P < 0.05), and age ≦48 was associated with a faster improvement in clinical status (HR = 1.709, 95% CI, 1.044–2.799, P < 0.05). The multivariate model including age ≦48 (HR = 1.837, 95% CI, 1.093–3.086, P = 0.022) and the subxiphoid approach (HR = 1.892, 95% CI, 1.127–3.177, P = 0.016) was significantly associated with a faster improvement in clinical status.ConclusionsIn patients with Masaoka stage I and II thymoma who underwent thymectomy, with tumor size less than 5 cm and thymomatous MG, age ≦48 years and the subxiphoid approach were associated with a rapid improvement in clinical status.

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Section: Discussionsupporting

confidence: 88%

Section: Discussionmentioning

confidence: 90%

Section: Discussionmentioning

confidence: 99%

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Neurological outcomes of extended thymectomy for thymomatous myasthenia gravis: Subxiphoid vs. trans-sternal approaches

et al. 2022

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“…Carbon dioxide at 8 cmH 2 O pressure (1 cmH 2 O ¼ 0.098 kPa) was insufflated, and using the index finger as a guide, 5-mm puncture guides were inserted below the left and right rib margins as operative ports to establish the surgical system. [4][5][6][7] Both groups of patients underwent thymoma resection and lymph node dissection, which included resection of the thymoma and surrounding fat, lymph node dissection, and resection of invaded organs or tissues if necessary. In the subcostal thoracoscopy group, the surgery was performed using only a pair of grasping forceps and an ultrasonic scalpel.…”

Section: Surgical Positioning and Techniquesmentioning

confidence: 99%

Comparative study of the clinical efficacy of subcostal thoracoscopy and median sternotomy in treating thymoma: a propensity score-matching analysis

Yin,

Xue,

Guo

et al. 2024

J Int Med Res

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Objective This study was performed to evaluate the clinical efficacy of subcostal thoracoscopy and median sternotomy as surgical approaches for thymoma resection and lymph node dissection. The feasibility, safety, and clinical outcomes of subcostal thoracoscopy were compared with those of median sternotomy. Methods The clinical data of 335 patients with thymoma were retrospectively analyzed. The patients were divided into the subcostal thoracoscopy group and the median sternotomy group. Propensity score matching was performed to obtain comparable subsets of 50 patients in each group. A comparative analysis was conducted on various parameters. Results All surgeries were successful, and no conversions to open thoracotomy were required in the subcostal thoracoscopy group. Significant differences in the operative time, intraoperative blood loss, chest tube drainage duration, postoperative hospital stay, patient satisfaction scores, pain assessment, and postoperative complications were observed between the two groups. However, there was no significant difference in the number of lymph nodes or lymph node stations dissected intraoperatively between the two groups. Conclusion Subcostal thoracoscopy is not inferior to median sternotomy as a surgical approach for thymoma resection and lymph node dissection. Our research provides important new comparative data on minimally invasive thymoma resection.

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“…Overall, 237 studies were searched from PubMed and Embase databases. After abstract/title screening and fulltext reading, 14 eligible studies were finally included in our meta-analysis according to the selection criteria (9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20)(21)(22).…”

Section: Literature Search and Study Selectionmentioning

confidence: 99%

Feasibility of Video-Assisted Thoracoscopic Surgery via Subxiphoid Approach in Anterior Mediastinal Surgery: A Meta-Analysis

Luo

et al. 2022

Front. Surg.

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BackgroundAccumulating researches show potential advantages of video-assisted thoracoscopic surgery (VATS) via the subxiphoid approach, and this meta-analysis aims to investigate the efficacy and safety of the subxiphoid approach for anterior mediastinal surgery.MethodsRelevant studies were retrieved by searching Embase and PubMed databases (from the inception to October 1, 2021). Primary outcomes included postoperative pain, intraoperative blood loss, operation time, chest tube duration, and hospital length of stay. All meta-analyses were performed by using random-effects models.ResultsOverall, 14 studies with 1,279 patients were included, with 504 patients undergoing anterior mediastinal surgery via subxiphoid approach and 775 via other approaches. The pooled results indicated that the subxiphoid approach was associated with reduced postoperative pain indicated by visual analog scale [weight mean difference (WMD): 24 h: −2.27, 95% CI, −2.88 to −1.65, p < 0.001; 48–72 h: −1.87, 95% CI, −2.53 to −1.20, p < 0.001; 7 days: −0.98, 95% CI, −1.35 to −0.61, p < 0.001], shortened duration of chest tube drainage (WMD: −0.56 days, 95% CI, −0.82 to −0.29, p < 0.001), shortened hospital length of stay (WMD: −1.46 days, 95% CI, −2.28 to −0.64, p < 0.001), and reduced intraoperative blood loss (WMD: −26.44 mL, 95% CI, −40.21 to −12.66, p < 0.001) by comparison with other approaches in anterior mediastinal surgery. Besides, it has no impact on operation time and the incidence of complications of transition to thoracotomy, postoperative pleural effusion, phrenic nerve palsy, and lung infection.ConclusionsOur study suggests that the subxiphoid approach is a feasible alternative approach and even can be a better option for anterior mediastinal surgery. Further, large-scale multicenter randomized controlled trials are needed to validate this finding.

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Subxiphoid-subcostal thoracoscopic thymectomy for seropositive myasthenia offers equivalent remission rates and potentially faster recovery

Cited by 12 publications

References 28 publications

Neurological outcomes of extended thymectomy for thymomatous myasthenia gravis: Subxiphoid vs. trans-sternal approaches

Neurological outcomes of extended thymectomy for thymomatous myasthenia gravis: Subxiphoid vs. trans-sternal approaches

Comparative study of the clinical efficacy of subcostal thoracoscopy and median sternotomy in treating thymoma: a propensity score-matching analysis

Feasibility of Video-Assisted Thoracoscopic Surgery via Subxiphoid Approach in Anterior Mediastinal Surgery: A Meta-Analysis

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