Surgical treatment of mediastinal tumors combined with myasthenia gravis: comparison of Da Vinci robot-assisted, video-assisted thoracoscopic surgery and median sternotomy_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

KANG Yunteng , XU Shiguang , LIU Bo , WANG Xilong , XU Wei , DING Renquan , LI Bo , WANG Tong , LIU Xingchi , MENG Hao , TENG Hong ,  WANG Shumin

Department of Thoracic Surgery, General Hospital of Shenyang Military Command, Shenyang, 110000, P.R.China;

Corresponding author：

WANG Shumin, Email: sureman2003congo@163.com

Keywords：

Myasthenia gravis; extended thymectomy; robotic surgery; thoracoscopy; median sternotomy

DOI：

10.7507/1007-4848.201804072

Video：

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Objective To compare three surgical treatments for mediastinal mass with myasthenia gravis. Methods Retrospective analysis was performed on the clinical data of 53 patients who underwent extended thymectomy between January 2010 and December 2017 in our hospital. There were 29 males and 24 females, aged 17-73 years. Patients were divided into three groups according to the surgical methods: a group A (video-assisted thoracoscopic surgery with the da Vinci robotic system, n=22), a group B (video-assisted thoracoscopic surgery, n=12) and a group C (median sternotomy, n=19). The gender distribution, age, intraoperative blood loss, operation time, postoperative extubation time, postoperative hospital stay, Osserman classification of myasthenia gravis, postoperative myasthenic remission rate, etc were compared in three groups. Results No perioperative death was observed in 53 patients. One patient in the group C suffered from postoperative myasthenic crisis and improved after active treatment. One patient with video-assisted thoracoscopic surgery was converted to median sternotomy due to the intraoperative injury of the left brachiocephalic vein. Compared with the group B and group C, the group A had shorter operation time, less intraoperative blood loss and drainage on the first postoperative day and fewer days of extubation. Postoperative hospital stay was less in the group A than that in the group C (P<0.05). The postoperative myasthenic remission rate was higher in the group A than that in the other two groups, but there was no statistical difference. Conclusion Because of the robot’s unique minimally invasive advantage, in this study, the outcome of patients with myasthenia gravis treated with Da Vinci robots and thymectomy is better than that of the remaining two groups in terms of perioperative outcomes and myasthenic remission rate. But long-term results and a large of number matching experiments are needed to confirm. However, it is undeniable that robotic surgery must be the future of the minimally invasive surgery.

Citation： KANG Yunteng, XU Shiguang, LIU Bo, WANG Xilong, XU Wei, DING Renquan, LI Bo, WANG Tong, LIU Xingchi, MENG Hao, TENG Hong, WANG Shumin. Surgical treatment of mediastinal tumors combined with myasthenia gravis: comparison of Da Vinci robot-assisted, video-assisted thoracoscopic surgery and median sternotomy. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2018, 25(12): 1027-1031. doi: 10.7507/1007-4848.201804072 Copy

1.	Schumacher R, Roth JJ. Thymektomie bei cenem fall vonmorbus basedowii mit myasthenia. Med Chir, 1912, 25: 746.
2.	中国免疫学会神经免疫学分会, 中华医学会神经病学分会神经免疫学组. 重症肌无力诊段和治疗中国专家共识. 中国神经免疫学和神经病学杂志, 2012, 19(6): 401-408.
3.	Benatar M, Kaminski HJ, Quality Standards Subcommittee of the American Academy of Neurology. Evidence report: the medical treatment of ocular myasthenia(an evidence-based review): report of the Quality Standards Subcommittee of the American Academy of Neurology. Neurology, 2007, 68(24): 2144-2149.
4.	Skeie GO, Apostolski S, Evoli A, et al. Guidelines for treatment of autoimmune neuromuscular transmission disorders. Eur J Neurol, 2010, 17(7): 893-902.
5.	Jaretzki A 3rd, Barohn RJ, Ernstoff RM, et al. Myasthenia gravis: recommendations for clinical research standards. Task Force of the Medical Scientific Advisory Board of the Myasthenia Gravis Foundation of America. Ann Thorac Surg, 2000, 70(1): 327-334.
6.	李瑾, 尚珂. 重症肌无力患者胸腺切除术后发生肌无力危象的危险因素分析. 内科急危重症杂志, 2016, 22(4): 297-299.
7.	刘会平, 李剑锋, 吴怡成, 等. 电视胸腔镜胸腺扩大切除治疗重症肌无力 107 例临床分析. 中华外科杂志, 2005, 43(10): 625-627.
8.	Goldstein SD, Yang SC. Assessment of robotic thymectomy using the Myasthenia Gravis Foundation of America Guidelines. Ann Thorac Surg, 2010, 89(4): 1080-1085.
9.	王述民, 李博, 许世广, 等. 达芬奇机器人在胸腺扩大切除术治疗Ⅰ型重症肌无力的应用. 中国胸心血管外科临床杂志, 2013, 20(6): 679-682.
10.	中华医学会神经病学分会神经免疫学组, 中国免疫学会神经免疫学分会. 中国重症肌无力诊断和治疗指南 2015. 中华神经科杂志, 2015, 48(11): 934-940.
11.	王述民, 许世广, 童向东, 等. 达芬奇机器人手术系统在胸外科纵隔肿瘤切除术中的应用体会. 临床军医杂志, 2013, 41(12): 1247-1249.
12.	Wang S, Xu S, Liu B. Resection of huge retrosternal goiter through a novel combined cervical and robot-assisted approach. Artif Organs, 2014, 38(5): 431-433.
13.	刘星池, 许世广, 徐惟, 等. 完全无管化达芬奇机器人纵隔肿瘤切除手术在快速康复外科中应用. 临床军医杂志, 2016, 44(6): 569-570.
14.	Skeie GO, Apostolski S, Evoli A, et al. Guidelines for treatment of autoimmune neuromuscular transmission disorders. Eur J Neurol, 2010, 17(7): 893-902.
15.	Gilhus NE. Myasthenia gravis. N Engl J Med, 2017, 376(13): e25.
16.	Cakar F, Werner P, Augustin F, et al. A comparison of outcomes after robotic open extended thymectomy for myasthenia gravis. Eur J Cardiothorac Surg, 2007, 31(3): 501-504.
17.	Taioli E, Paschal PK, Liu B, et al. Comparison of conservative treatment and thymectomy on myasthenia gravis outcome. Ann Thorac Surg, 2016, 102(6): 1805-1813.
18.	Meyer DM, Herbert MA, Sobhani NC, et al. Comparative clinical outcomes of thymectomy for myasthenia gravis performed by extended transsternal and minimally invasive approaches. Ann Thorac Surg, 2009, 87(2): 385-390.
19.	Savcenko M, Wendt GK, Prince SL, et al. Video-assisted thymectomy for myasthenia gravis: an update of a single institution experience. Eur J Cardiothorac Surg, 2002, 22(6): 978-983.
20.	Rowse PG, Roden AC, Corl FM, et al. Minimally invasive thymectomy: the Mayo Clinic experience. Ann Cardiothorac Surg, 2015, 4(6): 519-526.
21.	许世广, 王述民. 做好达芬奇机器人肺叶切除手术前的准备工作—一个助手的经验分享. 实用医院临床杂志, 2015, 12(1): 35-38.

1. Schumacher R, Roth JJ. Thymektomie bei cenem fall vonmorbus basedowii mit myasthenia. Med Chir, 1912, 25: 746.
2. 中国免疫学会神经免疫学分会, 中华医学会神经病学分会神经免疫学组. 重症肌无力诊段和治疗中国专家共识. 中国神经免疫学和神经病学杂志, 2012, 19(6): 401-408.
3. Benatar M, Kaminski HJ, Quality Standards Subcommittee of the American Academy of Neurology. Evidence report: the medical treatment of ocular myasthenia(an evidence-based review): report of the Quality Standards Subcommittee of the American Academy of Neurology. Neurology, 2007, 68(24): 2144-2149.
4. Skeie GO, Apostolski S, Evoli A, et al. Guidelines for treatment of autoimmune neuromuscular transmission disorders. Eur J Neurol, 2010, 17(7): 893-902.
5. Jaretzki A 3rd, Barohn RJ, Ernstoff RM, et al. Myasthenia gravis: recommendations for clinical research standards. Task Force of the Medical Scientific Advisory Board of the Myasthenia Gravis Foundation of America. Ann Thorac Surg, 2000, 70(1): 327-334.
6. 李瑾, 尚珂. 重症肌无力患者胸腺切除术后发生肌无力危象的危险因素分析. 内科急危重症杂志, 2016, 22(4): 297-299.
7. 刘会平, 李剑锋, 吴怡成, 等. 电视胸腔镜胸腺扩大切除治疗重症肌无力 107 例临床分析. 中华外科杂志, 2005, 43(10): 625-627.
8. Goldstein SD, Yang SC. Assessment of robotic thymectomy using the Myasthenia Gravis Foundation of America Guidelines. Ann Thorac Surg, 2010, 89(4): 1080-1085.
9. 王述民, 李博, 许世广, 等. 达芬奇机器人在胸腺扩大切除术治疗Ⅰ型重症肌无力的应用. 中国胸心血管外科临床杂志, 2013, 20(6): 679-682.
10. 中华医学会神经病学分会神经免疫学组, 中国免疫学会神经免疫学分会. 中国重症肌无力诊断和治疗指南 2015. 中华神经科杂志, 2015, 48(11): 934-940.
11. 王述民, 许世广, 童向东, 等. 达芬奇机器人手术系统在胸外科纵隔肿瘤切除术中的应用体会. 临床军医杂志, 2013, 41(12): 1247-1249.
12. Wang S, Xu S, Liu B. Resection of huge retrosternal goiter through a novel combined cervical and robot-assisted approach. Artif Organs, 2014, 38(5): 431-433.
13. 刘星池, 许世广, 徐惟, 等. 完全无管化达芬奇机器人纵隔肿瘤切除手术在快速康复外科中应用. 临床军医杂志, 2016, 44(6): 569-570.
14. Skeie GO, Apostolski S, Evoli A, et al. Guidelines for treatment of autoimmune neuromuscular transmission disorders. Eur J Neurol, 2010, 17(7): 893-902.
15. Gilhus NE. Myasthenia gravis. N Engl J Med, 2017, 376(13): e25.
16. Cakar F, Werner P, Augustin F, et al. A comparison of outcomes after robotic open extended thymectomy for myasthenia gravis. Eur J Cardiothorac Surg, 2007, 31(3): 501-504.
17. Taioli E, Paschal PK, Liu B, et al. Comparison of conservative treatment and thymectomy on myasthenia gravis outcome. Ann Thorac Surg, 2016, 102(6): 1805-1813.
18. Meyer DM, Herbert MA, Sobhani NC, et al. Comparative clinical outcomes of thymectomy for myasthenia gravis performed by extended transsternal and minimally invasive approaches. Ann Thorac Surg, 2009, 87(2): 385-390.
19. Savcenko M, Wendt GK, Prince SL, et al. Video-assisted thymectomy for myasthenia gravis: an update of a single institution experience. Eur J Cardiothorac Surg, 2002, 22(6): 978-983.
20. Rowse PG, Roden AC, Corl FM, et al. Minimally invasive thymectomy: the Mayo Clinic experience. Ann Cardiothorac Surg, 2015, 4(6): 519-526.
21. 许世广, 王述民. 做好达芬奇机器人肺叶切除手术前的准备工作—一个助手的经验分享. 实用医院临床杂志, 2015, 12(1): 35-38.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Surgical treatment of mediastinal tumors combined with myasthenia gravis: comparison of Da Vinci robot-assisted, video-assisted thoracoscopic surgery and median sternotomy

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