Kuzmych Khrystyna, Nachira Dania, Evoli Amelia, Iorio Raffaele, Sassorossi Carolina, Congedo Maria Teresa, Spagni Gregorio, Senatore Alessia, Calabrese Giuseppe, Margaritora Stefano, Meacci Elisa
Department of General Thoracic Surgery, Fondazione Policlinico Universitario "A. Gemelli", IRCCS, Università Cattolica del Sacro Cuore, 00168 Rome, Italy.
Institute of Neurology, Fondazione Policlinico Universitario "A. Gemelli", IRCCS, Università Cattolica del Sacro Cuore, 00168 Rome, Italy.
Life (Basel). 2025 Feb 26;15(3):371. doi: 10.3390/life15030371.
While the safety and feasibility of robotic thymectomy have been well documented through several studies, the surgical and long-term neurological outcomes in patients with thymomatous myasthenia gravis (MG), particularly in advanced stages, remain scarce. This study aims to evaluate the surgical outcomes in patients undergoing robotic-assisted thymectomy (RATS) for thymoma and to analyze neurological outcomes in patients with myasthenia.
Out of 128 robotic thymectomies performed at our institution between October 2013 and January 2022, clinical and pathological data from 55 patients diagnosed with thymoma were reviewed. Of these, thirty (54.5%) patients had concomitant acetylcholine-receptor-antibody-associated MG. Neurological outcomes were assessed using the Myasthenia Gravis Foundation of America post-intervention score (MGFA-PIS).
Thirty-nine (70.9%) procedures were performed using the left-sided approach. The mean operative time was 196.9 ± 79.9 min in patients with MG compared to 175.8 ± 61.6 min in non-MG patients ( = 0.285). Additionally, patients with MG had a longer in-hospital stay (4.8 ± 2.6 vs. 3.3 ± 2.2 days, = 0.01) and a significantly higher need for intensive care unit admission ( < 0.01). No deaths were reported. The rates of conversions (3.3% vs. 4.0%, = 0.895) and complications ( = 0.813) were comparable between the myasthenic and non-myasthenic thymomas. A multivariable analysis identified lung involvement ( = 0.023), vascular involvement ( = 0.04), and extended resection ( = 0.019) as significant risk factors for conversion and complications. The mean age of surgery for patients with MG was 54.5 ± 15.9 years. After a mean follow-up period of 35.6 ± 25.7 months, 18 (60%) patients with myasthenia showed clinical improvement of their condition. Specifically, 2 patients (6.6%) achieved complete stable remission (CSR), 2 (6.6%) experienced pharmacological remission (PR), 12 (40.0%) demonstrated minimal manifestation (MM), and 4 (13.3%) exhibited a combination of PR and MM. Twelve patients (40%) exhibited no changes, maintaining a stable clinical condition. No clinical worsening was observed. The overall improvement rates at 2 years and 5 years were 38% and 83%, respectively.
RATS thymectomy is a safe and feasible approach for patients with thymoma. Patients with coexisting MG may benefit through a good rate of neurological improvement.
虽然多项研究已充分证明机器人胸腺切除术的安全性和可行性，但胸腺瘤型重症肌无力（MG）患者，尤其是晚期患者的手术及长期神经学结局仍较为少见。本研究旨在评估接受机器人辅助胸腺切除术（RATS）治疗胸腺瘤患者的手术结局，并分析重症肌无力患者的神经学结局。
回顾了2013年10月至2022年1月在我院进行的128例机器人胸腺切除术，分析了55例诊断为胸腺瘤患者的临床和病理数据。其中，30例（54.5%）患者合并乙酰胆碱受体抗体相关MG。采用美国重症肌无力基金会干预后评分（MGFA-PIS）评估神经学结局。
39例（70.9%）手术采用左侧入路。MG患者的平均手术时间为196.9±79.9分钟，非MG患者为175.8±61.6分钟（P=0.285）。此外，MG患者的住院时间更长（4.8±2.6天对3.3±2.2天，P=0.01），重症监护病房收治需求显著更高（P<0.01）。无死亡报告。重症肌无力和非重症肌无力胸腺瘤的中转率（3.3%对4.0%，P=0.895）和并发症发生率（P=0.813）相当。多变量分析确定肺受累（P=0.023）、血管受累（P=0.04）和扩大切除（P=0.019）是中转和并发症的显著危险因素。MG患者的平均手术年龄为54.5±15.9岁。平均随访35.6±25.7个月后，18例（60%）重症肌无力患者病情出现临床改善。具体而言，2例（6.6%）实现完全稳定缓解（CSR），2例（6.6%）达到药物缓解（PR），12例（40.0%）表现为最小表现（MM），4例（13.3%）表现为PR和MM的组合。12例（40%）患者无变化，临床状况保持稳定。未观察到临床恶化。2年和5年的总体改善率分别为38%和83%。
RATS胸腺切除术对胸腺瘤患者是一种安全可行的方法。合并MG的患者可能通过较高的神经学改善率获益。
