Comparison Between Video-assisted Thoracoscopic Extended Thymectomy And Transsternal Thymectomy For Myasthenia Gravis With Thymoma

Objective To evaluate the clinical outcomes of video-assisted thoracoscoscopic extended thymectomy in myasthenia gravis (MG) with thymoma.Methods Clinicopathologic data were obtained from 51 patients with MG, who underwent extended thymectomy at the Affiliated Provincial Hospital of Anhui Medical University between January 2008 and December 2014 Diagnosis of thymoma was confirmed by postoperative pathological examination. Among them,31 patients (vats group) underwen video-assisted thoracoscoscopic extended thymectomy, and 20 patients (open group) underwent transsternal extended thymectomy. The operational factors, early and long-term outcomes of patients between the two groups were compared.Results Thymectomy and anterior mediastinal fat dissection were successfully performed for all patients, and 2 cases in vats group were converted to open surgery because of the invasion of brachiocephalic vein and aorta. All groups had one case of MG crisis was presented, and had no death case. There was no significant differences in operation time, postoperative morbidity, and delayed pulling rate of tracheal intubation between the two groups (P>0.05). Intraoperatve bleeding, postoperative hospital stay and time of chest drainge tube left were significantly decreased in vats group, compared to open group (P<0.05). Postoperative followed-up was performed to evaluate the long-term outcomes between the two groups. Follow-up data included 28 patients of vats group and 19 patients of open group were available, and median follow-up was 23 months (range 6-53 months). The complete stable remission, effective and recurrence rates were respectively 21.4%,78.6% and 7.1% in the patients of vats group, and were respectively 26.3%,84.2% and 5.3% in the patients of open group. There was no significant differences between the two groups for these factors (P>0.05).Conclusion video-assisted thoracoscoscopic extended thymectomy is comparable with transsternal extended thymectomy in both safety and curability for the treatment of myasthenia gravis with resectable thymoma, and with its specific advantages of less blood loss and rapid recovery.