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Minimally invasive thymectomy for myasthenia gravis favours left-sided approach and low severity class.

Publication ,  Journal Article
Wilshire, CL; Blitz, SL; Fuller, CC; Rückert, JC; Li, F; Cerfolio, RJ; Ghanim, AF; Onaitis, MW; Sarkaria, IS; Wigle, DA; Joshi, V; Reznik, S ...
Published in: Eur J Cardiothorac Surg
October 22, 2021

OBJECTIVES: Complete thymectomy is a key component of the optimal treatment for myasthenia gravis. Unilateral, minimally invasive approaches are increasingly utilized with debate about the optimal laterality approach. A right-sided approach has a wider field of view, while a left-sided approach accesses potentially more thymic tissue. We aimed to assess the impact of laterality on perioperative and medium-term outcomes, and to identify predictors of a 'good outcome' using standard definitions. METHODS: We performed a multicentre review of 123 patients who underwent a minimally invasive thymectomy for myasthenia gravis between January 2000 and August 2015, with at least 1-year follow-up. The Myasthenia Gravis Foundation of America standards were followed. A 'good outcome' was defined by complete stable remission/pharmacological remission/minimal manifestations 0, and a 'poor outcome' by minimal manifestations 1-3. Univariate and multivariable logistic regression analyses were performed to assess factors associated with a 'good outcome'. RESULTS: Ninety-two percent of thymectomies (113/123) were robotic-assisted. The left-sided approach had a shorter median operating time than a right-sided: 143 (interquartile range, IQR 110-196) vs 184 (IQR 133-228) min, P = 0.012. At a median of 44 (IQR 27-75) months, the left-sided approach achieved a 'good outcome' (46%, 31/68) more frequently than the right-sided (22%, 12/55); P = 0.011. Multivariable analysis identified a left-sided approach and Myasthenia Gravis Foundation of America class I/II to be associated with a 'good outcome'. CONCLUSIONS: A left-sided thymectomy may be preferred over a right-sided approach in patients with myasthenia gravis given the shorter operating times and potential for superior medium-term symptomatic outcomes. A lower severity class is also associated with a 'good outcome'.

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Published In

Eur J Cardiothorac Surg

DOI

EISSN

1873-734X

Publication Date

October 22, 2021

Volume

60

Issue

4

Start / End Page

898 / 905

Location

Germany

Related Subject Headings

  • Treatment Outcome
  • Thymectomy
  • Robotics
  • Retrospective Studies
  • Respiratory System
  • Myasthenia Gravis
  • Humans
  • 3201 Cardiovascular medicine and haematology
  • 1102 Cardiorespiratory Medicine and Haematology
 

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Wilshire, C. L., Blitz, S. L., Fuller, C. C., Rückert, J. C., Li, F., Cerfolio, R. J., … Louie, B. E. (2021). Minimally invasive thymectomy for myasthenia gravis favours left-sided approach and low severity class. Eur J Cardiothorac Surg, 60(4), 898–905. https://doi.org/10.1093/ejcts/ezab014
Wilshire, Candice L., Sandra L. Blitz, Carson C. Fuller, Jens C. Rückert, Feng Li, Robert J. Cerfolio, Asem F. Ghanim, et al. “Minimally invasive thymectomy for myasthenia gravis favours left-sided approach and low severity class.Eur J Cardiothorac Surg 60, no. 4 (October 22, 2021): 898–905. https://doi.org/10.1093/ejcts/ezab014.
Wilshire CL, Blitz SL, Fuller CC, Rückert JC, Li F, Cerfolio RJ, et al. Minimally invasive thymectomy for myasthenia gravis favours left-sided approach and low severity class. Eur J Cardiothorac Surg. 2021 Oct 22;60(4):898–905.
Wilshire, Candice L., et al. “Minimally invasive thymectomy for myasthenia gravis favours left-sided approach and low severity class.Eur J Cardiothorac Surg, vol. 60, no. 4, Oct. 2021, pp. 898–905. Pubmed, doi:10.1093/ejcts/ezab014.
Wilshire CL, Blitz SL, Fuller CC, Rückert JC, Li F, Cerfolio RJ, Ghanim AF, Onaitis MW, Sarkaria IS, Wigle DA, Joshi V, Reznik S, Bograd AJ, Vallières E, Louie BE. Minimally invasive thymectomy for myasthenia gravis favours left-sided approach and low severity class. Eur J Cardiothorac Surg. 2021 Oct 22;60(4):898–905.
Journal cover image

Published In

Eur J Cardiothorac Surg

DOI

EISSN

1873-734X

Publication Date

October 22, 2021

Volume

60

Issue

4

Start / End Page

898 / 905

Location

Germany

Related Subject Headings

  • Treatment Outcome
  • Thymectomy
  • Robotics
  • Retrospective Studies
  • Respiratory System
  • Myasthenia Gravis
  • Humans
  • 3201 Cardiovascular medicine and haematology
  • 1102 Cardiorespiratory Medicine and Haematology