Subxiphoid and subcostal arch thoracoscopic versus unilateral thoracoscopic thymectomy for the treatment of thymic abnormalities with myasthenia gravis: A propensity-score matching study_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

YIN Xunliang , XUE Sha , ZHAO Zhengwei , CHENG Shaoyi , FENG Zheng , GUO Yize , ZHANG Tianyi ,  ZHANG Jing ,  ZHOU Yongan

Department of Thoracic Surgery, Tangdu Hospital, Air Force Military Medical University, Xi’an, 710038, P.R.China;

Corresponding author：

ZHANG Jing, Email: 76538803@qq.com; ZHOU Yongan, Email: zhou.yongan@163.com

Keywords：

Thymic tumor; video-assisted thoracic surgery; subxiphoid and subcostal arch; myasthenia gravis; propensity-score matching

DOI：

10.7507/1007-4848.202004061

Video：

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Objective To compare clinical effects of extended thymectomy for the treatment of thymic abnormalities with myasthenia gravis (MG) between subxiphoid and subcostal arch thoracoscopic resection (SR) and the unilateral thoracoscopic resection (UR) by a propensity-score matching analysis.Methods We retrospectively analyzed the clinical data of 612 patients who presented with MG and were admitted to Tangdu Hospital of Air Force Military Medical University between December 2011 and December 2018. Of these patients, 520 patients underwent subxiphoid and subcostal arch thoracoscopic extended thymectomy (a SR group) and 92 unilateral thoracoscopic extended thymectomy (a UR group). Ninety-two patients in the SR group were matched with the UR group by propensity-score matching analysis. There were 52 males and 40 females with an average age of 26-70 (50.2±10.3) years in the SR group, and 47 males and 45 females with an average age of 20-73 (51.5±12.1) years in the UR group. The operation time, intraoperative blood loss, thoracic drainage time, postoperative hospital stay, thorough adipose tissue removal, postoperative remission of MG, patients’ satisfaction score, pain and complications were compared and analyzed between the two groups.Results All operations were accomplished successfully, without conversion to thoracotomy of the two groups. There were statistical differences between the two groups in operation time (46.2±19.5 min vs. 53.4±23.5 min), chest drainage duration (0 d vs. 3.4±1.2 d), hospital stay (2.9±1.9 d vs. 3.6±1.7 d), patients’ satisfaction score (7.9±2.1 points vs. 6.7±1.2 points) and pain scores (all P<0.05). There were no statistical differences between the two groups in intraoperative blood loss (52.2±12.7 mL vs. 51.2±10.3 mL), peripheral adipose tissue removal (8.1±0.6 vs. 7.9±0.9), remission rate of MG (89.1% vs. 85.9%) and rate of postoperative complications (10.9% vs. 6.5%) (all P>0.05). Conclusion Subxiphoid and subcostal arch thoracoscopic extended thymectomy is a safe and feasible minimally invasive procedure for the management of MG with thymic abnormalities.

Citation： YIN Xunliang, XUE Sha, ZHAO Zhengwei, CHENG Shaoyi, FENG Zheng, GUO Yize, ZHANG Tianyi, ZHANG Jing, ZHOU Yongan. Subxiphoid and subcostal arch thoracoscopic versus unilateral thoracoscopic thymectomy for the treatment of thymic abnormalities with myasthenia gravis: A propensity-score matching study. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2021, 28(4): 473-478. doi: 10.7507/1007-4848.202004061 Copy

1.	Wolfe GI, Kaminski HJ, Aban IB, et al. Randomized trial of thymectomy in myasthenia gravis. N Engl J Med, 2016, 375(6): 511-522.
2.	Wolfe GI, Kaminski HJ, Aban IB, et al. Long-term effect of thymectomy plus prednisone versus prednisone alone in patients with non-thymomatous myasthenia gravis: 2-year extension of the MGTX randomised trial. Lancet Neurol, 2019, 18(3): 259-268.
3.	卢强, 李小飞, 周勇安, 等. “三孔式”经剑突肋缘下胸腺切除治疗重症肌无力. 中华胸部外科电子杂志, 2016, 3(2): 95-99.
4.	Blalock A, Mason MF, Morgan HJ, et al. Myasthenia gravis and tumors of the thymic region: report of a case in which the tumor was removed. Ann Surg, 1939, 110(4): 544-561.
5.	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. 重症肌无力诊断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.
6.	赵正维, 王海强, 周勇安, 等. 前纵隔病变微创切除手术的治疗进展. 医学综述, 2016, 22(24): 4856-4859.
7.	Sonett JR, Jaretzki A. Thymectomy for nonthymomatous myasthenia gravis: a critical analysis. Ann N Y Acad Sci, 2008, 1132: 315-328.
8.	王艳, 尹逊亮, 周勇安, 等. 剑突肋缘下三孔式胸腔镜下胸腺切除治疗重症肌无力的早期临床疗效及对生活质量的影响. 现代生物医学进展, 2019, 19(12): 2320-2324.
9.	Zhao J, Wang J, Zhao Z, et al. Subxiphoid and subcostal arch thoracoscopic extended thymectomy: a safe and feasible minimally invasive procedure for selective stage Ⅲ thymomas. J Thorac Dis, 2016, 8(Suppl 3): S258-264.
10.	Lu Q, Zhao J, Wang J, et al. Subxiphoid and subcostal arch "three ports" thoracoscopic extended thymectomy for myasthenia gravis. J Thorac Dis, 2018, 10(3): 1711-1720.
11.	Chao YK, Liu YH, Hsieh MJ, et al. Long-term outcomes after thoracoscopic resection of stage Ⅰ and Ⅱ thymoma: a propensity-matched study. Ann Surg Oncol, 2015, 22(4): 1371-1376.
12.	Gu ZT, Mao T, Chen WH, et al. Comparison of video-assisted thoracoscopic surgery and median sternotomy approaches for thymic tumor resections at a single institution. Surg Laparosc Endosc Percutan Tech, 2015, 25(1): 47-51.
13.	Agatsuma H, Yoshida K, Yoshino I, et al. Video-assisted thoracic surgery thymectomy versus sternotomy thymectomy in patients with thymoma. Ann Thorac Surg, 2017, 104(3): 1047-1053.

1. Wolfe GI, Kaminski HJ, Aban IB, et al. Randomized trial of thymectomy in myasthenia gravis. N Engl J Med, 2016, 375(6): 511-522.
2. Wolfe GI, Kaminski HJ, Aban IB, et al. Long-term effect of thymectomy plus prednisone versus prednisone alone in patients with non-thymomatous myasthenia gravis: 2-year extension of the MGTX randomised trial. Lancet Neurol, 2019, 18(3): 259-268.
3. 卢强, 李小飞, 周勇安, 等. “三孔式”经剑突肋缘下胸腺切除治疗重症肌无力. 中华胸部外科电子杂志, 2016, 3(2): 95-99.
4. Blalock A, Mason MF, Morgan HJ, et al. Myasthenia gravis and tumors of the thymic region: report of a case in which the tumor was removed. Ann Surg, 1939, 110(4): 544-561.
5. 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. 重症肌无力诊断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.
6. 赵正维, 王海强, 周勇安, 等. 前纵隔病变微创切除手术的治疗进展. 医学综述, 2016, 22(24): 4856-4859.
7. Sonett JR, Jaretzki A. Thymectomy for nonthymomatous myasthenia gravis: a critical analysis. Ann N Y Acad Sci, 2008, 1132: 315-328.
8. 王艳, 尹逊亮, 周勇安, 等. 剑突肋缘下三孔式胸腔镜下胸腺切除治疗重症肌无力的早期临床疗效及对生活质量的影响. 现代生物医学进展, 2019, 19(12): 2320-2324.
9. Zhao J, Wang J, Zhao Z, et al. Subxiphoid and subcostal arch thoracoscopic extended thymectomy: a safe and feasible minimally invasive procedure for selective stage Ⅲ thymomas. J Thorac Dis, 2016, 8(Suppl 3): S258-264.
10. Lu Q, Zhao J, Wang J, et al. Subxiphoid and subcostal arch "three ports" thoracoscopic extended thymectomy for myasthenia gravis. J Thorac Dis, 2018, 10(3): 1711-1720.
11. Chao YK, Liu YH, Hsieh MJ, et al. Long-term outcomes after thoracoscopic resection of stage Ⅰ and Ⅱ thymoma: a propensity-matched study. Ann Surg Oncol, 2015, 22(4): 1371-1376.
12. Gu ZT, Mao T, Chen WH, et al. Comparison of video-assisted thoracoscopic surgery and median sternotomy approaches for thymic tumor resections at a single institution. Surg Laparosc Endosc Percutan Tech, 2015, 25(1): 47-51.
13. Agatsuma H, Yoshida K, Yoshino I, et al. Video-assisted thoracic surgery thymectomy versus sternotomy thymectomy in patients with thymoma. Ann Thorac Surg, 2017, 104(3): 1047-1053.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Subxiphoid and subcostal arch thoracoscopic versus unilateral thoracoscopic thymectomy for the treatment of thymic abnormalities with myasthenia gravis: A propensity-score matching study

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