THE OUTCOMES OF THORACOSCOPIC SURGERY IN THYMECTOMY FOR MYASTHENIA GRAVIS

Abstract

Background: Myasthenia Gravis (MG) is an auto-immune disorder characterized by the production of abnormal antibodies to the Acetylcholine receptors at the neuromuscular juntion. Radical thymectomy in many forms of Myasthenia Gravis may lead to clinical improvement in 70–80% of cases. Our objectives were to demonstrate our short-term results of radical trans-sternal thymectomy.

Objectives: To analyze the outcome of video-assisted thoracoscopic surgical (VATS) extended thymectomy in Thoracic and Vascular Surgery Department, University Medical Center Ho Chi Minh City.

Methods: Retrospective analysis was conducted for patients with MG who underwent thymectomy between January 2015 and March 2019.

Results: 72 patients with MG underwent VATS thymectomy in our department and were subdivided into 2 groups: MG with thymoma (n=37) and MG without thymoma (n=35). Post-operative respiratory failure was 16.7%. Postoperative myasthenic crisis was 6,9%. Patients with grade I and IIA had recovery rate and improved symtoms more than grade IIB and III. The average treatment duration was 5,1 days, the average length of stay in hospital was 11.5 days. The outcomes (Pharmcologic Remission and Improved) after surgery kept increasing overtime: <1 month (80.3%); 3-6 months (79.3%), 1 year (84%), 3 years (87.5). Anti-acetylcholine receptor antibody was increase about 80% in pulmonary failure postoperative. Factors associated with prolonged postoperative endotracheal intubation, pulmonary failure and myasthenic crisis: elderly patients, corticosteroid therapy, Higher grades of Osserman's scale (IIB and III).

Conclusion: Video-assisted thoracoscopic surgery thymectomy can produce satisfactory results including improve symptoms and reduce patients’ risk of developing respiratory failure.

Keyword: myasthenia gravis, thymectomy, thymoma, non-thymomatous, thoracoscopy