Objective To assess the long-term results and relevant influencing factors of extended thymectomy and medicine-alone treatment of non-thymomatous myasthenia gravis (MG) patients. Methods We retrospectively analyzed the clinical data of 174 patients with non-thymomatous MG diagnosed and treated in our department from December 2009 to April 2017, including 81 males and 93 females, aged 13-88 (47.1±17.8) years. According to the different treatment methods, the patients were divided into two groups: an operation group (91 patients receiving extended thymectomy) and a medicine-alone group (83 patients receiving medical therapy alone). The efficacy was evaluated according to the Myasthenia Gravis Foundation of America (MGFA). Survival curves of the patients were plotted using the Kaplan-Meier method to evaluate the remission rate and survival rate. Cox regression analysis was used to assess the influencing factors of the outcomes. Results The patients were followed up for 3 to 94 (39.1±26.9) months. As a result, 29 patients (31.9%) achieved complete remission in the surgery group and 13 patients (15.7%) were completely relieved in the medicine-alone group (P=0.014). Further analysis showed that treatment pattern (P=0.018) and MG type (P=0.021) were the main factors related to the efficacy. Conclusion For patients with non-thymomatous MG, extended thymectomy is superior to the medicine-alone in terms of complete remission rate and the postoperative immunosuppression ratio.
ObjectiveTo systematically evaluate the efficacy of adjuvant radiotherapy after thymoma resection. MethodsThe PubMed, EMbase, The Cochrane Library, Web of Science, Wanfang, VIP, CNKI databases were systematically searched to find relevant literature comparing the efficacy and effectiveness of thymoma resection and thymoma resection+postoperative radiation therapy (PORT) for treating thymoma published from inception to January 2024. The Newcastle-Ottawa Scale (NOS) was used to evaluate the quality of included retrospective studies, and Review Manager 5.4 software was used to perform meta-analysis. ResultsA total of 23 articles were included, all of which were retrospective studies. There were a total of 13742 patients, including 6980 patients in the simple surgery group, with 3321 males and 3659 females, and an average age of 54.08 years; 6762 patients in the surgery+PORT group, with 3385 males and 3377 females, and an average age of 53.76 years. The NOS scores of the included literature were all≥7 points. The results of the meta-analysis showed that compared with the simple surgery group, the surgery+PORT group had higher 1-year overall survival rate [OR=0.32, 95%CI (0.25, 0.42), P<0.001], 3-year overall survival rate [OR=0.55, 95%CI (0.48, 0.64), P<0.001], 5-year overall survival rate [OR=0.66, 95%CI (0.58, 0.75), P<0.001], 10-year overall survival rate [OR=0.71, 95%CI (0.57, 0.88), P=0.002], 1-year disease-free survival rate [OR=0.47, 95%CI (0.23, 0.93), P=0.030], 5-year disease-free survival rate [OR=0.61, 95%CI (0.45, 0.84), P=0.003], 3-year disease-specific survival rate [OR=0.44, 95%CI (0.35, 0.55), P<0.001], 5-year disease-specific survival rate [OR=0.53, 95%CI (0.44, 0.63), P<0.001] and 10-year disease-specific survival rate [OR=0.53, 95%CI (0.35, 0.82), P=0.004]. But there was no statistically significant difference between the two groups in terms of 3-year disease-free survival rate [OR=0.86, 95%CI (0.61, 1.22), P=0.400], 10-year disease-free survival rate [OR=0.70, 95%CI (0.47, 1.05), P=0.080] and 1-year disease-specific survival rate [OR=0.83, 95%CI (0.55, 1.26), P=0.380]. ConclusionPORT after thymoma resection has more advantages than simple surgical treatment in terms of 1-, 3-, 5-, and 10-year overall survival, 1- and 5-year disease-free survival, and 3-, 5- and 10-year disease-specific survival.
Thymic epithelial tumors represent the most common neoplasms of the anterior mediastinum, while atypical type A thymoma is a rare subtype of thymoma. On the morphological basis of type A thymoma, this tumor exhibits some atypical histological features, such as abundant cells, increased mitotic counts, tumor necrosis, and increased Ki67 index. At present, the clinical and pathological data of this tumor is still available. Since it was formally named, 16 cases have been reported around the world. In order to improve the understanding of the disease, this article reviews the related literature and tries to elaborate the atypical type A thymoma from the aspects of pathological features, clinical manifestations, epidemiology and differential diagnosis.
ObjectiveTo investigate the safety and efficacy of totally no tube three-port thoracoscopic surgery (TNTT) for thymic tumor via lateral thoracic approach. MethodsThe clinical data of patients with thymoma admitted to the Department of Thoracic Surgery of the General Hospital of Northern Theater Command from November 2021 to May 2022 were retrospectively analyzed. The patients were divided into a TNTT group and a single utility port video-assisted thoracic surgery (SVATS) group according to different surgical methods. The clinical data were compared between the two groups. ResultsA total of 111 patients were collected. There were 44 patients in the TNTT group, including 20 males and 24 females, with an average age of 60.11±8.64 years, and 67 patients in the SVATS group, including 30 males and 37 females, with an average age of 62.40±7.92 years. There was no significant difference between the two groups in the baseline data (P>0.05). The postoperative hospital stay and intraoperative blood loss were shorter or less in the TNTT group (P<0.05), and the visual analogue scale score 48 hours after the operation was smaller in the SVATS group (P<0.05). ConclusionTNTT has a good surgical safety, and can shorten postoperative hospital stay, reduce intraoperative blood loss, and has significant advantages in enhanced recovery after surgery, but SVATS can reduce postoperative pain in patients.
Objective To compare the differences in clinicopathological features, molecular phenotypes, and prognosis between atypical type A thymoma (AAT) and classic type A thymoma (TAT), and to clarify the aggressive nature of AAT. Methods The data of AAT patients (AAT group) and classic TAT patients (TAT group) who underwent surgical resection for thymoma at West China Hospital of Sichuan University between January 2016 and November 2024 were retrospectively collected. Comparisons on the clinical data, histopathology, immunohistochemistry (CD20, Ki-67), GTF2I mutation status, and survival outcomes were performed between the two groups. Results A total of 53 patients were enrolled, including 22 in the AAT group and 31 in the TAT group. There was no significant difference in age, sex, or initial presenting symptoms between the two groups (P>0.05). Compared with the TAT group, the AAT group had larger tumors [(5.6±2.7) vs. (4.1±2.0) cm, P=0.043], a lower proportion of Masaoka stage Ⅰ (31.6% vs. 61.3%, P=0.041), and worse survival outcomes [progression-free survival: hazard ratio (HR)=2.87, 95% confidence interval (CI) (1.42, 5.81), P=0.004; overall survival: HR=1.96, 95%CI (1.02, 3.78), P=0.013]. Pathologically, the AAT group showed more mitotic figures (mean 6/2 mm2), and tumor necrosis was observed in 45.5% of cases. There was no statistically significant difference in the CD20 expression rate (20.0% vs. 41.9%), Ki-67 index [(11.0±6.0)% vs. (8.0±6.9)%], or GTF2I mutation rate (86.7% vs. 92.3%) between the two groups (P>0.05). Conclusions AAT is a subtype of TAT with distinct aggressive pathological features, including higher mitotic activity, a tendency for necrosis, and a greater propensity for recurrence and metastasis. Pathological diagnosis should integrate morphology and molecular testing to guide more aggressive treatment and follow-up strategies.
[Abstract]This study reports a case of an 83-year-old female patient with systemic severe myasthenia gravis (American Myasthenia Foundation class Ⅳb) and multiple comorbidities who achieved minimal clinical status through preoperative alemtuzumab treatment (10 mg/kg, once per week for 4 consecutive weeks). After undergoing robotic thymectomy, the patient remained clinically stable in the early postoperative period until the 5th day after surgery when she developed dysphagia. Despite intravenous immunoglobulin and other therapeutic interventions, the patient’s myasthenic symptoms continued to worsen, coughing was impaired, respiratory insufficiency intensified, non-invasive ventilation support was required, and pulmonary infection occurred. Clinical symptoms further deteriorated, with diarrhea, urinary tract infection, and progressive respiratory tract infection. She was subsequently transferred to the intensive care unit for invasive mechanical ventilation and therapeutic plasmapheresis. These interventions failed to halt the disease progression, which eventually led to multiple organ dysfunction syndrome, and the patient died. Notably, among the other 12 patients receiving alemtuzumab treatment during the same period, none experienced such severe complications. This case is exceptional, and a direct causal relationship between alemtuzumab and mortality risk cannot be established at this time. Further research is needed to clarify perioperative immune management strategies.
ObjectiveTo compare the perioperative outcomes of subxiphoid robot-assisted extended thymectomy (SRAET) and video-assisted thoracoscopic extended thymectomy (VATET) for myasthenia gravis complicated with thymoma.MethodsRetrospective analysis of 61 patients with myasthenia gravis combined with thymoma who were admitted to the Department of Thoracic Surgery, West China Hospital, Sichuan University from January 2017 to June 2019 was performed. All patients underwent extended thymectomy, and the patients were divided into a SRAET group and a VATET group. There were 26 patients in the SRAET group, including 11 males and 15 females, with an average age of 42.20±13.20 years. There were 35 patients in the VATET group, including 14 males and 21 females, with an average age of 45.00±13.00 years. The perioperative outcomes of the two groups including gender, age, operation time, intraoperative blood loss, conversion rate, postoperative drainage, tube removal time, drainage volume, visual analogue scale, hospital stay and postoperative complications were compared.ResultsThere was no conversion to thoracotomy, death or myasthenia crisis in both groups. The operation time (111.42±28.60 min vs. 103.71±26.20 min, P=0.845), intraoperative blood loss (32.31±23.84 mL vs. 63.57±132.22 mL, P=0.239), visual analogue scale at postoperative 24 h (2.46±0.76 vs. 2.40±0.74, P=0.751) and postoperative 48 h (2.12±0.77 vs. 2.26±0.56, P=0.407), complication rate (3.8% vs. 2.9%, P=0.675), drainage volume (206.85±130.09 mL vs. 276.86±173.46 mL, P=0.089) and hospital stay (5.81±2.52 d vs. 5.29±2.17 d, P=0.642) were not significantly different between the two groups. The visual analogue scale of the SRAET group at postoperative 72 h (1.12±0.65 vs. 1.86±0.91, P=0.001) was significantly lower than that of the VATET group.ConclusionSRAET is a safe and feasible method with less postoperative short-term pain, which is an alternative surgical treatment for myasthenia gravis complicated with thymoma.
ObjectiveTo compare clinical effects of enlarged thymectomy for the treatment of myasthenia gravis (MG) complicated with thymoma via subxiphoid and subcostal arch thoracoscopic resection versus median sternotomy resection. MethodsWe retrospectively analyzed the clinical data of patients with MG complicated with thymoma admitted in Tangdu Hospital of the Air Force Military Medical University between December 2011 and December 2021. Patients who underwent subxiphoid and subcostal arch thoracoscopic enlarged thymectomy were allocated to a SR group, and patients who underwent median sternotomy enlarged thymectomy were allocated to a MR group. Perioperative outcomes were compared between the two groups. ResultsA total of 456 patients were collected. There were 51 patients in the MR group, including 30 males and 21 females aged 23-66 (49.5±11.8) years. There were 405 patients in the SR group, among whom 51 patients were matched to the MR group by propensity score matching, including 28 males and 23 females aged 26-70 (47.2±12.2) years. The operations were accomplished successfully in all patients, and no conversion to thoracotomy occurred in the SR group. The SR group had advantages in the operation time, intraoperative blood loss, chest drainage duration, hospital stay time, patients’ satisfaction level, pain score and complications (all P<0.05). No statistical difference was found in the number of intraoperative lymph node dissection stations, number of intraoperative lymph nodes dissected or remission of MG between the two groups (P>0.05). ConclusionSubxiphoid and subcostal arch thoracoscopic enlarged thymectomy and lymphadenectomy is a safe, effective and feasible minimally invasive procedure for the treatment of MG complicated with thymoma.
摘要:目的:研究胸腺瘤與前縱隔(血管前間隙)淋巴瘤的MSCT表現,提高對二者的診斷與鑒別診斷能力。方法:回顧性分析經手術病理證實的30例胸腺瘤與18例血管前間隙淋巴瘤MSCT表現,著重觀察腫瘤的密度、形態及其與周圍結構的關系。結果:30例胸腺瘤中,24例良性胸腺瘤與鄰近大血管分界清晰,腫塊表現 “D”字或反“D”字狀,平掃CT值16~59 Hu,增強CT值20~110 Hu;6例侵襲性胸腺瘤邊界不清,呈分葉狀、不規則形,密度不均,平掃CT值23~42 Hu,增強CT值23~60 Hu。18例淋巴瘤中,單發于前上縱隔者6例,其余12例呈多結節、腫塊狀,侵入血管間隙生長,致大血管受壓,增強掃描呈輕度強化,常伴有其它部位淋巴結增大。結論:MSCT能清晰顯示胸腺瘤與前縱隔淋巴瘤的影像學表現特征,并能有效提高對二者的鑒別診斷。Abstract: Objective: To diagnosis and differentiate thymoma and malignant lymphoma in the anterior mediastinum on the basis of multislice CT (MSCT) imaging features. Methods:We retrospectively reviewed 30 cases with thymoma and 18 cases with malignant lymphoma proven by surgery and pathology.More attention was put on the density, morphology and relation with the surrounding structures of the tumors. Results: The CT manifestations of 30 cases of thymoma were shown as: For 24 cases of benign thymoma, the boundaries were clear, the shapes were “D” signs or contra“D” signs, CT attenuation value were 1659Hu and 20110Hu on unenhanced and contrastenhanced scanning. For 6 cases of malignant thymoma, the boundaries were unclear, the shapes were lobulated or irregular, the density was heterogeneous, CT attenuation value were 2342Hu and 2360Hu on unenhanced and contrastenhanced scanning. For 18 cases of malignant lymphoma, 6 cases were located at anterior mediastinum, 12 cases were nodes or multiple mass, enveloped the neighboring vessel structures, mildly enhanced on contrastenhanced scanning, and associated with enlargement of lymph nodes in other place. Conclusion: MSCT can display the imaging features of thymoma and anterior mediastinal lymphoma, and effectively differentiate thymoma and mediastinal lymphoma.
ObjectiveTo analyze the research hotspots and progress of surgical treatment of myasthenia gravis. MethodsThe top 100 most cited articles on surgical treatment of myasthenia gravis were identified by searching the Web of Science database, and a bibliometric analysis was conducted. ResultsThe publication year of the top 100 most cited articles ranged from 1939 to 2021, and the number of citations ranged from 55 to 850 per article. Most of the included articles were original research articles (75/100), which were mainly retrospective studies (64/75). The United States was the country with the most published articles and most citations, and Annals of Thoracic Surgery was the most sourced journal (n=20). Through VOSviewer analysis, high-density keywords were thymectomy, maximal thymectomy, extended thymectomy, transcervical thymectomy, thymoma, and autoantibodies. ConclusionThe scope of surgical resection, surgical approach and pathogenesis are the current hotspots in the field of surgical treatment of myasthenia gravis. It is hoped that this paper can provide references for future researches in this field.