Dinesh Francis K Balasingam, Benedict Dharmaraj, Diong Nguk Chai, Narendran Balasubbiah, Palaniappan Meiyappan, Narasimman Sathiamurthy
{"title":"吉隆坡医院的单门视频辅助胸腔镜胸腺切除术:对胸腺瘤性和非胸腺瘤性重症肌无力患者治疗效果的回顾性观察。","authors":"Dinesh Francis K Balasingam, Benedict Dharmaraj, Diong Nguk Chai, Narendran Balasubbiah, Palaniappan Meiyappan, Narasimman Sathiamurthy","doi":"10.21037/jtd-24-830","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>The standard treatment for thymomatous myasthenia gravis (TMG) patients is thymectomy, whereas its role in non-TMG (NTMG) is still under debate. The objective of this study is to assess myasthenia gravis (MG) outcomes of thymectomy using the uniportal video-assisted thoracoscopic surgery (UVATS) technique for both groups and evaluate the procedure's efficacy and safety.</p><p><strong>Methods: </strong>We retrospectively collected data from January 2019 to December 2022 at Hospital Kuala Lumpur. The Myasthenia Gravis Activities of Daily Living (MG-ADL) scoring and the Myasthenia Gravis Foundation of America's Post Interventional Score (MGFA-PIS) measured our primary outcome. Secondary outcomes included surgery-related morbidity. All patients underwent a UVATS thymectomy, with the incision at the right anterior axillary line at the 5<sup>th</sup> intercostal space.</p><p><strong>Results: </strong>Out of 26 patients, 22 were analysed. The MG-ADL scores indicated a significant mean score reduction post-surgery [6.9; 95% confidence interval (CI): 4.42 to 9.67; P<0.001]. NTMG patients exhibited a greater decrease in MG-ADL mean score than TMG patients {9.5 [standard deviation (SD) 4.8] <i>vs</i>. 6.1 (SD 5.4) P<0.001}. The MGFA-PIS showed complete stable remission (CSR) rates of 43% for TMG and 25% for NTMG patients. Surgical morbidity was observed in 13% of patients, of which were myasthenic crisis, difficult extubation due to carbon dioxide (CO<sub>2</sub>) retention and subcutaneous emphysema.</p><p><strong>Conclusions: </strong>Thymectomy via UVATS is an effective and safe approach for improving symptoms in both TMG and NTMG patients.</p>","PeriodicalId":17542,"journal":{"name":"Journal of thoracic disease","volume":"16 11","pages":"7446-7457"},"PeriodicalIF":2.1000,"publicationDate":"2024-11-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11635260/pdf/","citationCount":"0","resultStr":"{\"title\":\"Uniportal video-assisted thoracoscopic thymectomy in Hospital Kuala Lumpur: a retrospective observational review of outcomes for patients diagnosed with thymomatous and non-thymomatous myasthenia gravis.\",\"authors\":\"Dinesh Francis K Balasingam, Benedict Dharmaraj, Diong Nguk Chai, Narendran Balasubbiah, Palaniappan Meiyappan, Narasimman Sathiamurthy\",\"doi\":\"10.21037/jtd-24-830\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Background: </strong>The standard treatment for thymomatous myasthenia gravis (TMG) patients is thymectomy, whereas its role in non-TMG (NTMG) is still under debate. The objective of this study is to assess myasthenia gravis (MG) outcomes of thymectomy using the uniportal video-assisted thoracoscopic surgery (UVATS) technique for both groups and evaluate the procedure's efficacy and safety.</p><p><strong>Methods: </strong>We retrospectively collected data from January 2019 to December 2022 at Hospital Kuala Lumpur. The Myasthenia Gravis Activities of Daily Living (MG-ADL) scoring and the Myasthenia Gravis Foundation of America's Post Interventional Score (MGFA-PIS) measured our primary outcome. Secondary outcomes included surgery-related morbidity. All patients underwent a UVATS thymectomy, with the incision at the right anterior axillary line at the 5<sup>th</sup> intercostal space.</p><p><strong>Results: </strong>Out of 26 patients, 22 were analysed. The MG-ADL scores indicated a significant mean score reduction post-surgery [6.9; 95% confidence interval (CI): 4.42 to 9.67; P<0.001]. NTMG patients exhibited a greater decrease in MG-ADL mean score than TMG patients {9.5 [standard deviation (SD) 4.8] <i>vs</i>. 6.1 (SD 5.4) P<0.001}. The MGFA-PIS showed complete stable remission (CSR) rates of 43% for TMG and 25% for NTMG patients. Surgical morbidity was observed in 13% of patients, of which were myasthenic crisis, difficult extubation due to carbon dioxide (CO<sub>2</sub>) retention and subcutaneous emphysema.</p><p><strong>Conclusions: </strong>Thymectomy via UVATS is an effective and safe approach for improving symptoms in both TMG and NTMG patients.</p>\",\"PeriodicalId\":17542,\"journal\":{\"name\":\"Journal of thoracic disease\",\"volume\":\"16 11\",\"pages\":\"7446-7457\"},\"PeriodicalIF\":2.1000,\"publicationDate\":\"2024-11-30\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11635260/pdf/\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Journal of thoracic disease\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.21037/jtd-24-830\",\"RegionNum\":3,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"2024/11/8 0:00:00\",\"PubModel\":\"Epub\",\"JCR\":\"Q3\",\"JCRName\":\"RESPIRATORY SYSTEM\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Journal of thoracic disease","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.21037/jtd-24-830","RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2024/11/8 0:00:00","PubModel":"Epub","JCR":"Q3","JCRName":"RESPIRATORY SYSTEM","Score":null,"Total":0}
Uniportal video-assisted thoracoscopic thymectomy in Hospital Kuala Lumpur: a retrospective observational review of outcomes for patients diagnosed with thymomatous and non-thymomatous myasthenia gravis.
Background: The standard treatment for thymomatous myasthenia gravis (TMG) patients is thymectomy, whereas its role in non-TMG (NTMG) is still under debate. The objective of this study is to assess myasthenia gravis (MG) outcomes of thymectomy using the uniportal video-assisted thoracoscopic surgery (UVATS) technique for both groups and evaluate the procedure's efficacy and safety.
Methods: We retrospectively collected data from January 2019 to December 2022 at Hospital Kuala Lumpur. The Myasthenia Gravis Activities of Daily Living (MG-ADL) scoring and the Myasthenia Gravis Foundation of America's Post Interventional Score (MGFA-PIS) measured our primary outcome. Secondary outcomes included surgery-related morbidity. All patients underwent a UVATS thymectomy, with the incision at the right anterior axillary line at the 5th intercostal space.
Results: Out of 26 patients, 22 were analysed. The MG-ADL scores indicated a significant mean score reduction post-surgery [6.9; 95% confidence interval (CI): 4.42 to 9.67; P<0.001]. NTMG patients exhibited a greater decrease in MG-ADL mean score than TMG patients {9.5 [standard deviation (SD) 4.8] vs. 6.1 (SD 5.4) P<0.001}. The MGFA-PIS showed complete stable remission (CSR) rates of 43% for TMG and 25% for NTMG patients. Surgical morbidity was observed in 13% of patients, of which were myasthenic crisis, difficult extubation due to carbon dioxide (CO2) retention and subcutaneous emphysema.
Conclusions: Thymectomy via UVATS is an effective and safe approach for improving symptoms in both TMG and NTMG patients.
期刊介绍:
The Journal of Thoracic Disease (JTD, J Thorac Dis, pISSN: 2072-1439; eISSN: 2077-6624) was founded in Dec 2009, and indexed in PubMed in Dec 2011 and Science Citation Index SCI in Feb 2013. It is published quarterly (Dec 2009- Dec 2011), bimonthly (Jan 2012 - Dec 2013), monthly (Jan. 2014-) and openly distributed worldwide. JTD received its impact factor of 2.365 for the year 2016. JTD publishes manuscripts that describe new findings and provide current, practical information on the diagnosis and treatment of conditions related to thoracic disease. All the submission and reviewing are conducted electronically so that rapid review is assured.