Division of Thoracic Surgery, Department of Cardiac and Thoracic Surgery, University of Pisa, Pisa, Italy.
Division of Thoracic Surgery, Department of Cardiac and Thoracic Surgery, University of Pisa, Pisa, Italy.
Ann Thorac Surg. 2021 Dec;112(6):1782-1789. doi: 10.1016/j.athoracsur.2020.12.010. Epub 2021 Aug 7.
Thymoma and myasthenia gravis share several pathogenetic aspects including the role of surgery as a therapeutic option. Extended thymectomy is associated with excellent survival and good local control, especially in early stages, and its role for the neurologic disease has been recently validated. The aim of this study is evaluating oncologic and neurologic outcomes of myasthenic patients with thymoma who underwent extended thymectomy.
We retrospectively collected surgical, oncologic, and neurologic data of all myasthenic patients with thymoma who underwent extended thymectomy at our department from January 1994 to December 2016. Clinical and pathologic data, neurologic remission rate, and overall survival and disease-free interval were analyzed.
In all, 219 patients underwent extended thymectomy. The B2 histotype was the most represented thymoma (24.2%), and the most prevalent pathologic Masaoka stage was IIB (37.9%). The overall survival and disease-free survival were statistically different between early stage and advanced stage. During the surveillance, 33 patients (15.1%) had recurrences, treated in 21 cases with iterative surgery. Regarding neurologic outcomes, 75 patients (34.2%) reached a complete stable remission, 84 (38.4%) a pharmacologic remission, 51 (23.3%) had an improvement of their symptoms, and in 9 patients (4.1%) myasthenia was unchanged or worsened.
Surgery is a cornerstone in the treatment of patients with both thymoma and myasthenia gravis. Extended thymectomy, as proposed by Masaoka, offers considerable oncologic outcomes with an excellent survival and low recurrence rate of thymoma; moreover, surgery leads to remarkable neurologic results.
胸腺瘤和重症肌无力具有一些共同的发病机制，包括手术作为一种治疗选择。广泛胸腺切除术与极好的生存和良好的局部控制相关，尤其是在早期阶段，其对神经疾病的作用最近已得到验证。本研究旨在评估接受广泛胸腺切除术的胸腺瘤合并重症肌无力患者的肿瘤学和神经学结果。
我们回顾性收集了 1994 年 1 月至 2016 年 12 月期间在我院接受广泛胸腺切除术的所有胸腺瘤合并重症肌无力患者的手术、肿瘤学和神经学数据。分析了临床和病理数据、神经缓解率以及总生存率和无病间隔。
共有 219 例患者接受了广泛胸腺切除术。B2 组织学类型是最常见的胸腺瘤（24.2%），最常见的病理 Masaoka 分期为 IIB 期（37.9%）。早期和晚期的总生存率和无病生存率存在统计学差异。在随访期间，33 例患者（15.1%）复发，其中 21 例患者接受了迭代手术治疗。在神经学结果方面，75 例患者（34.2%）达到完全稳定缓解，84 例（38.4%）达到药物缓解，51 例（23.3%）症状改善，9 例（4.1%）肌无力无变化或恶化。
手术是胸腺瘤和重症肌无力患者治疗的基石。Masaoka 提出的广泛胸腺切除术提供了相当大的肿瘤学结果，具有极好的生存和低胸腺瘤复发率；此外，手术还能带来显著的神经学效果。
