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Value of Adjuvant Radiotherapy for Thymoma with Myasthenia Gravis after Extended thymectomy

Chinese Medical Journal 2018年第8期131卷 927-932页

作者： Chang-Feng Lu Lei YU Yun Jing Yun-Feng Zhang Ji Ke Department of Neurology Beijing Tongren Hospital Capital Medical University Beijing 100730 China Department of Thoracic Surgery Beijing Tongren Hospital Capital Medical University Beijing 100730 China

Background：The co-existence of myasthenia gravis （MG） and thymoma makes the surgical treatment more complicated and adjuvant radiation more controversial. The aim of this study was to investigate adjuvant radiotherapy for thymoma with MG after extended thymectomy.Methods：A total of 181 patients with both MG and thymoma were recruited between 2003 and 2014 at Tongren Hospital, China. Among all the patients, 157 patients received radiation therapy after surgery （Group A）; whereas the other 24 patients did not receive radiation therapy （Group B）. According to the time that patients started mediastinal radiation therapy, we subdivided the 157 patients in Group A into subgroups （1-month subgroup, n = 98; 2-month subgroup, n = 7; and 3-month subgroup, n = 52）. We then compared the effect of the mediastinal radiation therapy across these different groups using the survival rate, the rate of postoperative myasthenic crisis, and the complete stable remission （CSR） rate as the primary endpoints.Results：There was a significant difference in the occurrence of postoperative myasthenic crisis between 1-month subgroup and Group B （χ2 = 4.631, P = 0.031）. The rates of reaching CSR were 32.6% in 1-month subgroup, 25% in 3-month subgroup, and 22.7% in Group B, respectively. The overall survival rates of 1-month subgroup, 3-month subgroup, and Group B were 88.8%, 83.3%, and 77.3%, respectively. Analysis on the Kaplan-Meier survival curves demonstrated that within 8 years after surgery, there was no significant difference in aspects of overall survival and disease-free survival between 1-month subgroup and Group B, and between 3-month subgroup and Group B; over 8 years after surgery, the disease-free survival rates in 1-month subgroup, 3-month subgroup and Group B were 79.4%, 70.6%, and 55.3%, respectively.Conclusions：Adjuvant radiation within 1 month after extended thymectomy may be helpful in controlling postoperative MG, such as decreasing the possibility of postoperative myasthenic crisis, and raising cumulative probabilities of

关键词： Myasthenia Gravis Prognosis Radiotherapy thymectomy Thymoma

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Predictors of postoperative myasthenic crisis in patients with myasthenia gravis after thymectomy

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Chinese Medical Journal 2011年第8期124卷 1246-1250页

作者： CHU Xiang-yang XUE Zhi-qiang WANG Ru-wen TAN Qun-you aDepartment of Thoracic Surgery Chinese People's LiberationArmy General Hospital Beijing 100853 China Department of Thoracic Surgery Daping Hospital Third MilitaryMedical University Chongqing 400042 China

Background thymectomy is considered the most effective treatment in patients with myasthenia gravis. This study aimed to explore the predictors of postoperative myasthenic crisis in patients with myasthenia gravis after thymectomy.Methods Clinical records of 243 patients with myasthenia gravis who underwent thymectomy were reviewed retrospectively. The following factors were analyzed in relation to the occurrence of myasthenic crisis after thymectomy：gender, age, duration of symptoms, Osserman stage, history of myasthenic crisis, concomitant diseases, preoperative pyridostigmine dose, preoperative steroid therapy, operation approach, operation time, presence of thymoma, major postoperative complications.Results Forty-four patients experienced postoperative myasthenic crisis during the first month after thymectomy.Univariate analysis revealed that Osserman stage （RR=0.0976, P=0.000）, history of myasthenic crisis （RR=0.2309,P=0.012）, preoperative pyridostigmine dose （RR=0.4349, P=0.016）, thymoma （RR=0.0606, P=0.000）, and major postoperative complications （RR=0.1094, P=0.000） were significantly related to postoperative myasthenic crisis.Multivariate Logistic regression analysis showed that Osserman stage （Ⅱb＋Ⅲ＋Ⅳ）（RR=0.0953, P=0.000）, thymoma （RR=0.0294, P=0.000）, and major postoperative complications （RR=0.0424, P=0.000） independently predict postoperative myasthenic crisis.Conclusion Osserman stage （Ⅱb＋Ⅲb＋Ⅳ）, thymoma and major postoperative complications are independent predictors of postoperative myasthenic crisis in patients with myasthenia gravis who underwent thymectomy.

关键词： myasthenia gravis thymoma thymectomy

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Perioperative and long-term outcome of thymectomy for myasthenia gravis： comparison of surgical approaches and prognostic analysis

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Chinese Medical Journal 2013年第1期126卷 34-40页

作者： LIU Cheng-wu LUO Meng MEI Jian-dong ZHU Yun-ke PU Qiang MA Lin CHE Guo-wei LIN Yi-dan WU Zhu WANG Yun KOU Ying-li LIU Lun-xu Department of Thoracic Surgery West China Hospital SichuanUniversity Chengdu Sichuan 610041 China Department of Thoracic Surgery Guizhou Provincial People'sHospital Guiyang Guizhou 550002 China

Background thymectomy is an established treatment for myasthenia gravis （MG）, and video-assisted thoracoscopic surgery （VATS） thymectomy has become an acceptable surgical procedure. This study aimed to compare the results of VATS thymectomy and open thymectomy and to identify the prognostic factors after thymectomy. Methods The clinical data of 187 consecutive thymectomies performed between July 2000 and December 2009 were retrospectively reviewed; 75 open thymectomies and 112 VATS thymectomies. Clinical efficacy and variables influencing outcome were assessed by Kaplan-Meier survival curves and Cox proportional hazards regression analysis. Results The operative blood loss in the VATS group was significantly less than that in the open group （（62.14＋55.43） ml vs. （137.87＋165.25） ml, P 〈0.05）. The postoperative crisis rate increased with the severity of preoperative MG and the prescription dose of anticholinesterase. Complete follow-up information of patients more than 12 months after the thymectomy was obtained on 151 cases, 89 cases from the VATS group and 62 cases from the open group, with a mean follow-up period of 59.3 months, range from 12 to 117 months. Complete stable remission （CSR） was the end point for evaluation of the treatment results. The overall five-year CSR rate was 57.5%. Two good prognostic factors were identified; preoperative prescription of anticholinesterase alone （P=0.035） and non-thymomatous MG （P=0.003）. The five-year CSR rate of the ocular type of MG reached a high level of 67.4%. Conclusions thymectomy can achieve good long-term CSR in MG, and VATS is an ideal alternative method. High-dose prescription of anticholinesterase and the advanced stage by Myasthenia Gravis Foundation of America （MGFA） classification have higher risks of postoperative crisis. Preoperative prescription of anticholinesterase alone and non-thymomatous MG are good prognostic factors. thymectomy should also be considered for the ocular tvioe of MG.

关键词： myasthenia gravis thymectomy video-assisted thoracoscopic surgery transsternal thymectomy prognosis

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An improved method for rat intubation and thymectomy

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Chinese Medical Journal 2011年第17期124卷 2723-2727页

作者： NA Ning ZHAO Da-qiang HUANG Zheng-yu HONG Liang-qing Department of Renal Transplantation Third Affiliated Hospital of Sun Yat-sen University Guangzhou Guangdong 510630 China

Background Thymokidney has been reported as an approach for a vascularized thymus for transplantation to induce donor specific tolerance. A completely thymectomized model which ensures that the obtained thymus is not injured has not been developed yet and it would be useful for evaluating autologous thymokidney function in rats. Methods Adult Sprague-Dawley male rats weighing 150-300 g （n=30） underwent non-invasive intubation with the assistance of an improved self-made wedge-shaped cannula made from a 2-ml plastic syringe and transillumination from the anterior tracheal area by an operation spotlight. The rats then received a thoracotomy while their breathing was supported by a small animal ventilator, and both lobes of the thymus were entirely extirpated under a 10x microscope. The postoperative survival rate of the rats was recorded, and changes in the T-cell reservoir from 9 of 30 rats within 21 days after surgery were monitored using flow cytometry. The complete thymectomy rate was confirmed by autopsy and histological examination on 21 days post-operation. Results The postoperative survival rate of rats was 100%. The exsected thymus was free of injury and the rate of complete thymectomy was 100%. Conclusions This model has a stable survival rate and complete thymectomy is able to be achieved. The obtained thymus tissue is free of injury and can be used for transplantation.

关键词： thymectomy tracheal intubation rat

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Effectiveness of thymectomy in Non-thymomatous Myasthenia Gravis: a Systematic Review

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Journal of Huazhong University of Science and Technology(Medical Sciences) 2014年第6期34卷 942-949页

作者：罗彦潘邓记陈菲菲朱明辉王晶张旻 Department of Neurology Tongji Hospital Tongji Medical College Huazhong University of Science and Technology

There is continuous debate regarding the effectiveness of thymectomy in the treatment of non-thymomatous myasthenia gravis （MG）. This systematic review was undertaken to determine whether thymectomy was effective in non-thymomatous MG. We retrieved articles published between January 1980 and September 2013. Sixteen cohort studies were included. Given the considerable het- erogeneity, we used a descriptive method instead of statistical synthesis. The median relative rates （RRs） and their interquartile ranges were used to estimate the magnitude of benefit. Compared to conserva- tively treated MG patients, thymectomized patients had higher survival, clinical remission, pharma- cologic remission and improvement rates, and RRs were 1.07 （1.01-1.17）, 1.83 （0.82-2.99）, 1.55 （1.22-1.95） and 1 （1.00-1.09）, respectively. Subgroup analyses showed that patients with moderate to severe generalized MG benefited more from thymeetomy, with RRs of survival and pharmacologic re- mission increasing to 1.35 （1.24-1.49） and 2.68 （1.73-4.17）, respectively. These results suggested that thymectomy might be an effective procedure in non-thymomatous MG patients. The patients with mod- erate to severe generalized MG might benefit more. Taking into account the poor methodological qual- ity of present studies, more well-designed prospective randomized controlled trials （RCTs） are still re- quired to reach uneouivocal conclusion.

关键词： myasthenia gravis thymectomy systematic review

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Surgical approaches for stage Ⅰ and Ⅱ thymoma-associated myasthenia gravis:feasibility of complete video-assisted thoracoscopic surgery (VATS) thymectomy in comparison with trans-sternal resection

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The Journal of Biomedical Research 2013年第1期27卷 62-70页

作者： Zhicheng He Quan Zhu Wei Wen Liang Chen Hai Xu Hai Li Department of Thoracic Surgery the First Affiliated HospitalNanjing Medical University Department of Radiology the First Affiliated HospitalNanjing Medical University Department of Pathology the First Affiliated HospitalNanjing Medical University

Complete resection could be achieved in virtually all myasthenic patients with Masaoka stage I and II thymoma us- ing the trans-sternal technique. Whether this is appropriate for minimally invasive approach is not yet clear. We evalu- ated the feasibility of complete video-assisted thoracoscopic surgery （VATS） thymectomy for the treatment of Ma- saoka stage I and Ⅱ thymoma-associated myasthenia gravis, compared to conventional trans-sternal thymectomy. We summarized 33 patients with Masaoka stage I and II thymoma-associated myasthenia gravis between April 2006 and September 2011. Of these, 15 patients underwent right-sided complete VATS （the VATS group） by us- ing adjuvant pneuomomediastinum, comparing with 18 patients using the trans-sternal approach （the T3b group）. No intraoperative death was found and no VATS case required conversion to median sternotomy. Significant differences between the two groups regarding duration of surgery and volume of intraoperative blood loss （P = 0.001 and P 〈 0.001, respectively） were observed. Postoperative morbidities were 26.7% and 33.3% for the VATS and T3b groups, respectively. All 33 patients were followed up for 12 to 61 months in the study. The cumulative probabilities of reaching complete stable remission and effective rate were 26.7% （4/15） and 93.3% （14/15） in the VATS group, which had a significantly higher complete stable remission and effective rate than those in the T3b group （P = 0.026 and P = 0.000, respectively）. We conclude that VATS thymectomy utilizing adjuvant pneuomo- mediastinum for the treatment of stage I and II thymoma-associated myasthenia gravis is technically feasible but deserves further investigation in a large series with long-term follow-up.

关键词： video-assisted thoracoscopic surgery （VATS） thymoma thymectomy myasthenia gravis adjuvantpneuomomediastinum

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The Influence of thymectomy on Germ-cells of the Testis in Mice

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Journal of Huazhong University of Science and Technology(Medical Sciences) 1995年第2期15卷 112-116页

作者：曾进章咏裳任大洪 Department of Urological Surgery Tongji Hospital Wuhan Surgery Hospital of Heidelberg University Germany Department of Pathology Tongji Medical University Wuhan

We performed thymectomy on the immature and mature male mice and made a quantitative assay of various germ cells of tbe seminiferous epithelium in the testis with Image Analyser System 35 days following thymectomy. The results indicated that as compared with the control group, all germ cells of the spermatogenesis lineage decreased in the immature group and in the mature group after thymectomy.The present study showed that thymus and its hormone stimulated not only the mitotic division, but also the meiotic division of germ cells during spermatogenesis, suggesting that thymus-sexual axis may play an important role in the process of spermatogensis in the testis.

关键词： thymectomy division spermatogenesis testis morphometic analysis

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Intraoperative cardiogenic shock induced by refractory coronary artery spasm in a patient with myasthenia gravis: A case report

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World Journal of Clinical Cases 2023年第36期11卷 8589-8594页

作者： Cheng-Wei Hsu Chuen-Chau Chang Chao-Shun Lin Department of Anesthesiology Taipei Medical University HospitalTaipei 110Taiwan Department of Anesthesiology School of MedicineCollege of MedicineTaipei Medical UniversityTaipei 110Taiwan

BACKGROUND Coronary artery spasm(CAS)is a rare but critical condition during surgery.Clinical manifestations can vary from only subtle electrocardiography change to sudden death.In this case report,we present the case of a patient with myasthenia gravis(MG)who developed refractory CAS-related cardiogenic shock during thymoma surgery.CASE SUMMARY A 61-year-old man had a history of cigarette smoking and coronary artery disease with a bare metal stent placed.Three months ago,he suffered from coronary spasms,with three vessels involved,after surgery for cervical spine injury.He started having progressive dysphagia 4 wk prior and was diagnosed with MG via serologic tests,and computed tomography declared a thymoma in the anterior mediastinum.After the symptoms of MG subsided,he was referred for thy-mectomy.The operation was uneventful until the closing of the sternal wound.Electrocardiography showed sudden onset ST elevation,followed by ventricular tachycardia and severe hypotension.Cardiopulmonary cerebral resuscitation was initiated immediately with electrical defibrillation,extracorporeal membrane oxygenation was performed due to refractory cardiogenic shock,and the patient was transferred to an angiography room.Angiography showed diffuse CAS with three vessels involved.Intracoronary isosorbide dinitrate and adenosine were administered,and then the patient was transferred to the intensive care unit.CONCLUSION Our case highlights the importance of being prepared for clinical situations such as the one described here and suggests the necessity of developing an appropriate anesthesia plan that includes proactive analgesia and preemptive coronary vaso-dilators.

关键词： Coronary spasm Myasthenia gravis thymectomy Shock Case report

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Robotic–Assisted thymectomy in Patients with Nonthymomatous Myasthenia Gravis

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Surgical Science 2011年第7期2卷 393-396页

作者： Iskander Al-Githmi 不详

Complete removal of the thymus and fatty tissue adherent to pericardium is crucial for treating myasthenia gravis. Our aim was to analyze our surgical and clinical results and early experience of robot-assisted thy-mectomy in patients with nonthymomatous myasthenia gravis. Between January 2008 and October 2010, 8 patients, all women, with nonthymomatous myasthenia gravis underwent robot-assisted thymectomy using a 3-port, left-sided approach. There were no operative mortality;1 patient had left phrenic nerve injury. Com-plete remission was achieved in 25% of the patients at 18 months’ follow-up. There was no significant agreement between preoperative computed tomography and histopathology finding (kappa = 0.059;P = 0.85) and no significant correlation between age and duration of symptoms (P = 0.51). Robotic-assisted thymec-tomy is promising procedure. It can be performed safely and effectively. With follow-up greater than 12 months, 87.5% of the patients who underwent robot-assisted thymectomy demonstrated clinical improve-ment.

关键词： Myasthenia Gravis Nonthymoma Robot thymectomy

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Effect of thymectomy for 36 children with myasthenia gravis

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Journal of Medical Colleges of PLA(China) 1999年第3期14卷 193-195页

作者：黄志勇王武军邹小明杨锡耀陈钢

objective: To analyze the effects of thymectomy for children with myasthenia gravis (MG).Methods: Thirty-six children with MG were treated by thymectomy from 1984 to 1997, their age ranging from 4 to 14 years, with symptom duration from 2 months to 8 years. According to Osserman’s classifica tion, 27 case belongs to class Ⅰ, 6 class Ⅱa, 2 class Ⅱb and 1 class Ⅲ. The outcome was graded as "much im proved", "improved", "unchanged" and "deteriorated or death". Results: 13. 9% of patients were much im proved, 69. 4% improved, so the better response to thymectomy (much improved or improved) is 83. 3%, which is significantly higher than the control group (without surgical treatment) 44. 8% (Pthymectomy for children with MG is safe and effective, and the out come after thymectomy relates to the duration of symptoms and pathologic classification, but irrelevant to sex and age, and the follow-up results were satisfactory.

关键词： myasthenia gravis thymectomy outcome

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