Lococo Filippo, Sassorossi Carolina, Maurizi Giulio, Santoro Gloria, Iorio Raffaele, Falso Silvia, Meacci Elisa, Napolitano Antonio Giulio, Congedo Maria Teresa, Cusumano Giacomo, Trabalza Marinucci Beatrice, Argento Giacomo, Chiappetta Marco, Rendina Erino Angelo, Margaritora Stefano
Thoracic Surgery Unit, Università Cattolica del Sacro Cuore, Largo F.Vito 1, Rome, Italy.
Thoracic Surgery Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy.
Updates Surg. 2024 Jul 9. doi: 10.1007/s13304-024-01937-w.
To increase the neurological results in patients older than 65 years with myasthenia gravis after thymectomy, we retrospectively analysed this outcome in a large bicentric cohort of patients with myasthenia gravis (MG)years, for which surgery was indicated for a concurrent thymoma. From 1/2000 to 2/2022, 502 patients underwent thymectomy for thymic epithelial tumours (TETs) in two high-volume Institutions (167aged more than 65 years). Among them, 66 patients were affected by TET and MG, representing our final study group. The mean age for MG onset was 68.3 ± 6 years.At surgery, the Osserman score 2 was the most diffuse in our cohort (43, 65.1%), followed by 1 (20, 30.3%). In 11 cases, the MG diagnosis coincided with thymoma diagnosis. In the other cases, the interval between MG diagnosis and surgery was 1.7 years ± 1.9. The most common surgical approach was sternotomy (41,62.1%), followed by RATS (14,21.2%). The most frequent TNM stage was T1N0 (75.7%) and most patients had WHO type-B tumour. After radical thymectomy, 58 patients (88%) reported a significant neurological improvement. According to MGFA-PIS, after surgery we had 4 (6%) complete stable remission, 11 (16.7%) pharmacological remission, 43 (65.2%) minimal manifestation, 2 (3%) worsening/death for MG, and 5 (7.6%) unchanged. No association was found between neurological outcome and age of MG onset, kind of pharmacological therapy before surgery, surgical approach (sternotomy vs others), tumour dimension, the ITMIG stage and the preoperative Osserman score. For MG and thymoma-afftected patients over 65 years, thymectomy seems to be an effective treatment to improve neurological symptoms. We suggest to set up clinical trials to explore the neurological efficacy of mini-invasive thymectomy in clinically selected MG patients aged over 65 years.
为提高65岁以上重症肌无力患者胸腺切除术后的神经学疗效，我们对一个大型双中心重症肌无力（MG）患者队列的这一结果进行了回顾性分析，这些患者因合并胸腺瘤而需要进行手术。从2000年1月至2022年2月，502例患者在两家高容量机构接受了胸腺上皮肿瘤（TET）胸腺切除术（167例年龄超过65岁）。其中，66例患者同时患有TET和MG，构成了我们的最终研究组。MG发病的平均年龄为68.3±6岁。手术时，Osserman评分2在我们的队列中最为常见（43例，65.1%），其次是1（20例，30.3%）。11例患者的MG诊断与胸腺瘤诊断同时出现。在其他病例中，MG诊断与手术之间的间隔为1.7年±1.9年。最常见的手术方式是胸骨切开术（41例，62.1%），其次是机器人辅助胸腔镜手术（RATS，14例，21.2%）。最常见的TNM分期是T1N0（75.7%），大多数患者患有WHO B型肿瘤。根治性胸腺切除术后，58例患者（88%）报告神经学症状有显著改善。根据MGFA-PIS，术后我们有4例（6%）完全稳定缓解，11例（16.7%）药物缓解，43例（65.2%）最小表现，2例（3%）因MG病情恶化/死亡，5例（7.6%）无变化。未发现神经学疗效与MG发病年龄、手术前药物治疗类型、手术方式（胸骨切开术与其他方式）、肿瘤大小、ITMIG分期和术前Osserman评分之间存在关联。对于65岁以上合并MG和胸腺瘤的患者，胸腺切除术似乎是改善神经学症状的有效治疗方法。我们建议开展临床试验，以探索微创胸腺切除术对65岁以上临床选择的MG患者的神经学疗效。
