Comparison of inflammatory reaction for patients with thymomas and myasthenia gravis treated by traditional thoracotomy or minimally invasive surgery_Chinese Journal of Evidence-Based Medicine

Authors：

SUN Peidao ^1,2 , YANG Yushang ¹ , HU Weipeng ¹ , CHEN Longqi ¹ ,  YUAN Yong ¹

1. Department of Thoracic Surgery, West China Hospital of Sichuan University, Chengdu, 610041, P.R.China;
2. Department of Cardiothoracic Surgery, Changle People’s Hospital, Weifang, 262400, P.R.China;

Corresponding author：

YUAN Yong, Email: dy818@sina.com

Keywords：

Thymoma; Myasthenia gravis; Video-assisted thoracoscopic surgery (VATS); Operative trauma; Inflammatory reaction

DOI：

10.7507/1672-2531.201701035

Video：

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Objective To investigate the effects of inflammatory reaction of thymomas with myasthenia gravis (MG) treated by traditional thoracotomy and minimally invasive surgery. Methods A total of 40 thymomas patients (Mssaoka Ⅰ or Ⅱ) with myasthenia gravis from August 2014 to June 2015 were treated by traditional thoracotomy (n=20) or video-assisted thoracoscopic surgery (n=20). The serum levels of IL-6, IL-8, TNF-α, CRP and CORT were measured by enzyme-linked immunosorbent assay (ELISA) methods at before anesthesia (T1), after anesthesia (T2), 2 h after skin cut (T3), 24 h post-operation (T4), 48 h post-operation (T5) and 72 h post-operation (T6) respectively. Perioperative parameters were also reported. The statistics analysis was performed by SPSS 17.0 software. Results The serum levels of IL-6, IL-8, TNF-α, CRP and CORT had no significant difference between T1 and T2, T2 and T3 (allP value>0.05) in both groups. But the serum levels of these factors after operation were obviously higher than that of before operation, commonly the highest level was reached at T4 (allP value>0.01), and also was higher at T6 than that of before the operation (allP value<0.01), except the level of TNF-α recovered rapidly to the level of before operation (allP value>0.05) in the VATS group. The operation time, postoperative drainage tube indwelling time and incision healing time in the VATS were lower than that in the control group (allP value<0.05). Conclusion VATS could be widely applied in clinical practice with lowering operative trauma and reducing the degree of inflammatory reaction.

Citation： SUN Peidao, YANG Yushang, HU Weipeng, CHEN Longqi, YUAN Yong. Comparison of inflammatory reaction for patients with thymomas and myasthenia gravis treated by traditional thoracotomy or minimally invasive surgery. Chinese Journal of Evidence-Based Medicine, 2017, 17(4): 383-388. doi: 10.7507/1672-2531.201701035 Copy

1.	Rowse PG, Roden AC, Corl FM,et al. Minimally invasive thymectomy: the mayo clinic experience. Ann Cardiothorac Surg, 2015, 4(6): 519-526.
2.	Muhammed J, Chen CY, Wan H,et al. Thymectomy for myasthenia gravis: a 10-year review of cases at the hospital university Sains Malaysia. Malays J Med Sci, 2016, 23(4): 71-78.
3.	Diaz A, Black E, Dunning J. Is thymectomy in non-thymomatous myasthenia gravis of any benefit? Interact Cardiovasc Thorac Surg, 2014, 18(3): 381-389.
4.	Hess NR, Sarkaria IS, Pennathur A,et al. Minimally invasive versus open thymectomy: a systematic review of surgical techniques, patient demographics, and perioperative outcomes. Ann Cardiothorac Surg, 2016, 5(1): 1-9.
5.	Coosemans W, Lerut TE, Van Raemdonck DE. Thoracoscopic surgery: the Belgian experience. Ann Thorac Surg, 1993, 56(3): 721-730.
6.	Ng CS, Whelan RL, Lacy AM,et al. Is minimal access surgery for cancer associated with immunologic benefits? World J Surg, 2005, 29(8): 975-981.
7.	Walker WS, Codispoti M, Soon SY,et al. Long-term outcomes following VATC lobectony for non-small cell bronchogenic carcinoma. Eur J Cardio-Thorac Surg, 2003, 23(3): 397-402.
8.	Oosterhuis HJ. The natural course of myasthenia gravis: a long term follow up study. J Neurol Neurosurg Psychiatr, 1989, 52(10): 1121-1127.
9.	Liu CW, Luo M, Mei JD,et al. Perioperative and long-term outcome of thymectomy for myasthenia gravis: comparison of surgical approaches and prognostic analysis. Chin Med J (Engl), 2013, 126(1): 34-40.
10.	Sablotzki A, Mann V, Simm A,et al. Changes in the cytokine net work through escalating SIRS after heart surgery. Anasthesiol Intensivmed Notfallmed Schmerzther, 2001, 36(9): 552-559.
11.	Sakamoto K, Hisanob S, Kamoharab H,et al. Changes of interleukin 6 and soluble IL-6 receptor levels after surgery .International Congress Series, 2003, 125(5): 135-142.
12.	Sakamoto K, Arakawa H, Mita S,et al. Elevation of circulating in terleukin 6 after surgery: factors influencing the serum level. Cytokine, 1994, 6(2): 181-186.
13.	Van Zee KJ, Fischer E, Hawes AS,et al. Effects of intravenous IL-8 administration in nonhuman primates. J Immunol, 1992, 148(6): 1746-1752.
14.	Ohzato H, Yoshizaki K, Nishimoto N,et al. Interleukin-6 as a new indicator of inflammatory status: detection of serum levels of Interleukin-6 and C-reactive protein after surgery. Surgery, 1992, 111(2): 201-209.
15.	Grande M, Tucci GF, Adorisio O,et al. Systemic acute-phase response after laparoscopic and open cholecystectomy. Surg Endosc, 2002, 16(2): 313-316．.
16.	蒲强, 马林, 梅建东, 等. 全胸腔镜与后外侧开胸对肺癌患者免疫功能影响的对比研究. 四川大学学报(医学版), 2013, 44(1): 126-129.
17.	Raza A, Woo E. Video-assisted thoracoscopic surgery versus sternotomy in thymectomy for thymoma and myasthenia gravis. Ann Cardiothorac Surg, 2016, 5(1): 33-37.
18.	Zahid I, Sharif S, Routledge T,et al. Video-assisted thoracoscopic surgery or transsternal thymectomy in the treatment of myasthenia gravis? Interact Cardiovasc Thorac Surg, 2011, 12(1): 40-46.
19.	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.

1. Rowse PG, Roden AC, Corl FM,et al. Minimally invasive thymectomy: the mayo clinic experience. Ann Cardiothorac Surg, 2015, 4(6): 519-526.
2. Muhammed J, Chen CY, Wan H,et al. Thymectomy for myasthenia gravis: a 10-year review of cases at the hospital university Sains Malaysia. Malays J Med Sci, 2016, 23(4): 71-78.
3. Diaz A, Black E, Dunning J. Is thymectomy in non-thymomatous myasthenia gravis of any benefit? Interact Cardiovasc Thorac Surg, 2014, 18(3): 381-389.
4. Hess NR, Sarkaria IS, Pennathur A,et al. Minimally invasive versus open thymectomy: a systematic review of surgical techniques, patient demographics, and perioperative outcomes. Ann Cardiothorac Surg, 2016, 5(1): 1-9.
5. Coosemans W, Lerut TE, Van Raemdonck DE. Thoracoscopic surgery: the Belgian experience. Ann Thorac Surg, 1993, 56(3): 721-730.
6. Ng CS, Whelan RL, Lacy AM,et al. Is minimal access surgery for cancer associated with immunologic benefits? World J Surg, 2005, 29(8): 975-981.
7. Walker WS, Codispoti M, Soon SY,et al. Long-term outcomes following VATC lobectony for non-small cell bronchogenic carcinoma. Eur J Cardio-Thorac Surg, 2003, 23(3): 397-402.
8. Oosterhuis HJ. The natural course of myasthenia gravis: a long term follow up study. J Neurol Neurosurg Psychiatr, 1989, 52(10): 1121-1127.
9. Liu CW, Luo M, Mei JD,et al. Perioperative and long-term outcome of thymectomy for myasthenia gravis: comparison of surgical approaches and prognostic analysis. Chin Med J (Engl), 2013, 126(1): 34-40.
10. Sablotzki A, Mann V, Simm A,et al. Changes in the cytokine net work through escalating SIRS after heart surgery. Anasthesiol Intensivmed Notfallmed Schmerzther, 2001, 36(9): 552-559.
11. Sakamoto K, Hisanob S, Kamoharab H,et al. Changes of interleukin 6 and soluble IL-6 receptor levels after surgery .International Congress Series, 2003, 125(5): 135-142.
12. Sakamoto K, Arakawa H, Mita S,et al. Elevation of circulating in terleukin 6 after surgery: factors influencing the serum level. Cytokine, 1994, 6(2): 181-186.
13. Van Zee KJ, Fischer E, Hawes AS,et al. Effects of intravenous IL-8 administration in nonhuman primates. J Immunol, 1992, 148(6): 1746-1752.
14. Ohzato H, Yoshizaki K, Nishimoto N,et al. Interleukin-6 as a new indicator of inflammatory status: detection of serum levels of Interleukin-6 and C-reactive protein after surgery. Surgery, 1992, 111(2): 201-209.
15. Grande M, Tucci GF, Adorisio O,et al. Systemic acute-phase response after laparoscopic and open cholecystectomy. Surg Endosc, 2002, 16(2): 313-316．.
16. 蒲强, 马林, 梅建东, 等. 全胸腔镜与后外侧开胸对肺癌患者免疫功能影响的对比研究. 四川大学学报(医学版), 2013, 44(1): 126-129.
17. Raza A, Woo E. Video-assisted thoracoscopic surgery versus sternotomy in thymectomy for thymoma and myasthenia gravis. Ann Cardiothorac Surg, 2016, 5(1): 33-37.
18. Zahid I, Sharif S, Routledge T,et al. Video-assisted thoracoscopic surgery or transsternal thymectomy in the treatment of myasthenia gravis? Interact Cardiovasc Thorac Surg, 2011, 12(1): 40-46.
19. 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.

Chinese Journal of Evidence-Based Medicine

Comparison of inflammatory reaction for patients with thymomas and myasthenia gravis treated by traditional thoracotomy or minimally invasive surgery

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