Li Jian-Feng, Hui Ben-Gang, Li Xiao, Xiao Rong-Xin, Jiang Guan-Chao, Liu Jun, Wang Jun
Department of Thoracic Surgery, Peking University People's Hospital, Beijing 100044, China.
J Thorac Dis. 2018 Jan;10(1):291-297. doi: 10.21037/jtd.2017.12.34.
The use of video-assisted thoracic surgery (VATS) in the treatment of thymoma is becoming more and more common. The aim of this study was to evaluate safety and effectiveness of thoracoscopic treatment of thymoma and, more importantly, to report long-term follow-up results of a large single-center cohort.
A retrospective review of a prospective database was performed. In total, 150 patients who underwent VATS resection for thymoma at Peking University People's Hospital from April 2001 to November 2014 were retrospectively reviewed.
Average operation time was 140.1±54.2 min, median blood loss was 50 mL (range, 10-700 mL), median post-operative drainage time was 3 days (range, 1-11 days), and median length of post-op stay was 5 days (range, 2-20 days); 134 patients (89.3%) were followed up successfully. Median follow-up was 59.5 months (range, 2-187 months). Five- and 10-year recurrence free survival (RFS) rates of entire group were 96.5% and 94.4%, respectively; 5- and 10-year RFS rates for Masaoka stages I + II were 98.1% and 98.1%, respectively; 5- and 6-year RFS rates for Masaoka stage III were 90% and 60%, respectively. One case of recurrence in five Masaoka stage IV patients was observed, and 4-year RFS was 80%. Multivariable analysis indicated that recurrence tended to occur in Masaoka stages III + IV patients (P=0.037, HR =12.69, 95% CI: 1.17-138.22) and older patients had a lower risk of recurrence (P=0.029, HR =0.87, 95% CI: 0.77-0.99). Myasthenia gravis (MG) presented in 44 patients (29.3%), of which 36 patients (81.8%) were followed up. Nine patients achieved complete remission, and 19 patients had symptom improvement after surgery. Overall response rate of MG was 77.8% (28/36).
VATS was a safe and effective procedure for treatment of thymomas with satisfactory prognosis. MG with thymoma treated by VATS had comparable neurological outcome to that associated with the trans-sternal approach.
电视辅助胸腔镜手术（VATS）在胸腺瘤治疗中的应用越来越普遍。本研究的目的是评估胸腔镜治疗胸腺瘤的安全性和有效性，更重要的是，报告一个大型单中心队列的长期随访结果。
对一个前瞻性数据库进行回顾性分析。总共回顾性分析了2001年4月至2014年11月在北京大学人民医院接受VATS切除胸腺瘤的150例患者。
平均手术时间为140.1±54.2分钟，中位失血量为50毫升（范围10 - 700毫升），术后中位引流时间为3天（范围1 - 11天），术后中位住院时间为5天（范围2 - 20天）；134例患者（89.3%）获得成功随访。中位随访时间为59.5个月（范围2 - 187个月）。全组5年和10年无复发生存（RFS）率分别为96.5%和94.4%；Masaoka I + II期患者的5年和10年RFS率分别为98.1%和98.1%；Masaoka III期患者的5年和6年RFS率分别为90%和60%。在5例Masaoka IV期患者中观察到1例复发，4年RFS为80%。多变量分析表明，复发倾向于发生在Masaoka III + IV期患者中（P = 0.037，HR = 12.69，95%CI：1.17 - 138.22），而老年患者复发风险较低（P = 0.029，HR = 0.87，95%CI：0.77 - 0.99）。44例患者（29.3%）出现重症肌无力（MG），其中36例患者（81.8%）获得随访。9例患者完全缓解，19例患者术后症状改善。MG的总体缓解率为77.8%（28/36）。
VATS是治疗胸腺瘤的一种安全有效的方法，预后良好。VATS治疗合并MG的胸腺瘤，其神经学转归与经胸骨入路相当。
