Minimally Invasive and Robotic Thoracic Surgery - Surgical, Medical, Molecular and Critical Care Pathology Department, University of Pisa, Pisa, Italy.
Surgical, Medical, Molecular and Critical Care Pathology Department, University of Pisa, Pisa, Italy.
Eur J Cardiothorac Surg. 2021 Oct 22;60(4):890-895. doi: 10.1093/ejcts/ezab253.
The goal of this study was to analyse the outcomes in 53 patients with thymoma, 34 of whom had myasthenia gravis (MG), who were treated with robotic surgery. The oncological outcomes of the whole series of patients were analysed. Furthermore, because consistent data are not yet available in the literature, the main focus was the analysis of the neurological results of the patients affected by MG and thymoma.
The clinical outcomes of 53 patients with a diagnosis of thymoma who underwent robotic thymectomy between January 2014 and December 2019 in our institution were collected and evaluated; 34 of these patients had a concomitant diagnosis of MG. The neurological status of the patients was determined from a clinical evaluation according to the Osserman classification and on pre- and post-surgery Myasthenia Gravis Composite scores, whereas neurological clinical outcomes were assessed using the Myasthenia Gravis Foundation of America Post-Intervention Score. Reduction of steroid therapy was also considered. The recurrence rate, adjuvant radiotherapy and overall survival of the patients with a thymoma were evaluated.
Neurological outcomes: improvement of the clinical conditions was obtained in 26 patients (76.5%) following the operation: complete stable remission was observed in 5 patients (14.7%), pharmacological remission in 10 (29.4%) and minimal manifestation in 11 (32.3%). Four patients (11.8%) exhibited no substantial change from the pretreatment clinical manifestations or reduction in MG medication and 4 (11.8%) patients experienced worsening of clinical conditions. In 21 patients (61.7%) a reduction of the dosage of steroid therapy was obtained. Oncological outcomes: at an average follow-up of 36 months, the overall survival was 96%, 4 patients (7.5%) had pleural relapses and 12 patients (22.6%) underwent postoperative radiotherapy, according to their stage. In accordance with Masaoka staging, 34% were in stage I, 56.6% in stage II and 9.4% in stage III.
Our results suggest that robotic surgical treatment of patients with thymoma and concomitant MG is effective in improving the neurological outcomes. Moreover, the oncological results obtained in this series confirm the efficacy of robotic surgery for the treatment of thymic malignancies, with results in line with those of open surgery. However, due to the indolent growth of thymomas, further observations with longer follow-up are necessary.
本研究旨在分析 53 例胸腺瘤患者的治疗效果，其中 34 例患有重症肌无力（MG）。分析所有患者的肿瘤学结果。此外，由于文献中尚无一致数据，本研究的重点是分析患有胸腺瘤和 MG 的患者的神经学结果。
收集并评估了 2014 年 1 月至 2019 年 12 月期间在我院接受机器人胸腺切除术的 53 例胸腺瘤患者的临床结果，其中 34 例患者同时诊断为 MG。根据 Osserman 分类和术前术后肌无力综合评分，对患者的神经状态进行临床评估，并采用美国重症肌无力基金会术后干预评分评估神经临床结果。还考虑了类固醇治疗的减少。评估了胸腺瘤患者的复发率、辅助放疗和总生存率。
神经学结果：术后 26 例（76.5%）患者临床状况改善：5 例（14.7%）完全稳定缓解，10 例（29.4%）药物缓解，11 例（32.3%）轻微缓解。4 例（11.8%）患者术前临床表现或 MG 药物用量无明显变化，4 例（11.8%）患者病情恶化。21 例（61.7%）患者类固醇治疗剂量减少。在平均 36 个月的随访中，总生存率为 96%，4 例（7.5%）患者出现胸膜复发，12 例（22.6%）患者根据分期接受术后放疗。根据 Masaoka 分期，34%为Ⅰ期，56.6%为Ⅱ期，9.4%为Ⅲ期。
我们的结果表明，机器人手术治疗伴 MG 的胸腺瘤患者可有效改善神经学结果。此外，本系列研究获得的肿瘤学结果证实了机器人手术治疗胸腺癌的有效性，结果与开放手术一致。然而，由于胸腺瘤生长缓慢，需要进一步观察更长时间的随访结果。
