Minimally invasive thymectomy for myasthenia gravis favours left-sided approach and low severity class
European Journal of Cardio-thoracic Surgery, ISSN: 1873-734X, Vol: 60, Issue: 4, Page: 898-905
2021
- 14Citations
- 13Usage
- 17Captures
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Metrics Details
- Citations14
- Citation Indexes14
- 14
- CrossRef1
- Usage13
- Abstract Views13
- Captures17
- Readers17
- 17
Article Description
OBJECTIVES: Complete thymectomy is a key component of the optimal treatment for myasthenia gravis. Unilateral, minimally invasive approaches are increasingly utilized with debate about the optimal laterality approach. A right-sided approach has a wider field of view, while a left-sided approach accesses potentially more thymic tissue. We aimed to assess the impact of laterality on perioperative and medium-term outcomes, and to identify predictors of a 'good outcome' using standard definitions. METHODS: We performed a multicentre review of 123 patients who underwent a minimally invasive thymectomy for myasthenia gravis between January 2000 and August 2015, with at least 1-year follow-up. The Myasthenia Gravis Foundation of America standards were followed. A 'good outcome' was defined by complete stable remission/pharmacological remission/minimal manifestations 0, and a 'poor outcome' by minimal manifestations 1-3. Univariate and multivariable logistic regression analyses were performed to assess factors associated with a 'good outcome'. RESULTS: Ninety-two percent of thymectomies (113/123) were robotic-assisted. The left-sided approach had a shorter median operating time than a right-sided: 143 (interquartile range, IQR 110-196) vs 184 (IQR 133-228) min, P = 0.012. At a median of 44 (IQR 27-75) months, the left-sided approach achieved a 'good outcome' (46%, 31/68) more frequently than the right-sided (22%, 12/55); P = 0.011. Multivariable analysis identified a left-sided approach and Myasthenia Gravis Foundation of America class I/II to be associated with a 'good outcome'. CONCLUSIONS: A left-sided thymectomy may be preferred over a right-sided approach in patients with myasthenia gravis given the shorter operating times and potential for superior medium-term symptomatic outcomes. A lower severity class is also associated with a 'good outcome'.
Bibliographic Details
http://www.scopus.com/inward/record.url?partnerID=HzOxMe3b&scp=85119326315&origin=inward; http://dx.doi.org/10.1093/ejcts/ezab014; http://www.ncbi.nlm.nih.gov/pubmed/33538299; https://academic.oup.com/ejcts/article/60/4/898/6128454; https://digitalcommons.providence.org/publications/4470; https://digitalcommons.providence.org/cgi/viewcontent.cgi?article=5323&context=publications; https://dx.doi.org/10.1093/ejcts/ezab014
Oxford University Press (OUP)
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