Thymoma resection and myasthenia gravis: what is the neurological outcome in patients older than 65 years?
Myasthenia gravis therapy
Surgery
Thymectomy
Journal
Updates in surgery
ISSN: 2038-3312
Titre abrégé: Updates Surg
Pays: Italy
ID NLM: 101539818
Informations de publication
Date de publication:
09 Jul 2024
09 Jul 2024
Historique:
received:
12
03
2024
accepted:
03
07
2024
medline:
9
7
2024
pubmed:
9
7
2024
entrez:
9
7
2024
Statut:
aheadofprint
Résumé
To increase the neurological results in patients older than 65 years with myasthenia gravis after thymectomy, we retrospectively analysed this outcome in a large bicentric cohort of patients with myasthenia gravis (MG)years, for which surgery was indicated for a concurrent thymoma. From 1/2000 to 2/2022, 502 patients underwent thymectomy for thymic epithelial tumours (TETs) in two high-volume Institutions (167aged more than 65 years). Among them, 66 patients were affected by TET and MG, representing our final study group. The mean age for MG onset was 68.3 ± 6 years.At surgery, the Osserman score 2 was the most diffuse in our cohort (43, 65.1%), followed by 1 (20, 30.3%). In 11 cases, the MG diagnosis coincided with thymoma diagnosis. In the other cases, the interval between MG diagnosis and surgery was 1.7 years ± 1.9. The most common surgical approach was sternotomy (41,62.1%), followed by RATS (14,21.2%). The most frequent TNM stage was T1N0 (75.7%) and most patients had WHO type-B tumour. After radical thymectomy, 58 patients (88%) reported a significant neurological improvement. According to MGFA-PIS, after surgery we had 4 (6%) complete stable remission, 11 (16.7%) pharmacological remission, 43 (65.2%) minimal manifestation, 2 (3%) worsening/death for MG, and 5 (7.6%) unchanged. No association was found between neurological outcome and age of MG onset, kind of pharmacological therapy before surgery, surgical approach (sternotomy vs others), tumour dimension, the ITMIG stage and the preoperative Osserman score. For MG and thymoma-afftected patients over 65 years, thymectomy seems to be an effective treatment to improve neurological symptoms. We suggest to set up clinical trials to explore the neurological efficacy of mini-invasive thymectomy in clinically selected MG patients aged over 65 years.
Identifiants
pubmed: 38980595
doi: 10.1007/s13304-024-01937-w
pii: 10.1007/s13304-024-01937-w
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Informations de copyright
© 2024. The Author(s).
Références
Deboever N, Xu Y, Feldman HA, Woodman KH, Chen M, Shih YCT, Rajaram R (2023) Outcomes after thymectomy in non-thymomatous myasthenia gravis. J Thorac Dis 15(6):3048–3053. https://doi.org/10.21037/jtd-22-1589
doi: 10.21037/jtd-22-1589
pubmed: 37426145
pmcid: 10323597
Bacci ED, Coyne KS, Poon JL et al (2019) Understanding side effects of therapy for myasthenia gravis and their impact on daily life. BMC Neurol 19:335
doi: 10.1186/s12883-019-1573-2
pubmed: 31864345
pmcid: 6925439
Pushpa N, Donald BS, Gil W, Michael B, Gabriel C, Amelia E, Nils Erik G, Isabel I, Nancy LK, Janice M, Arthur M, Hiroyuki M, Michael N, Jacqueline P, David R, Jan V (2021) International consensus guidance for management of myasthenia gravis 2020 update. Neurology. https://doi.org/10.1212/WNL.0000000000011124
doi: 10.1212/WNL.0000000000011124
Jiao P, Wu F, Wu J, Sun Y, Tian W, Yu H et al (2023) Surgical safety analysis and clinical experience sharing of myasthenia gravis patients aged 65 and over. Thorac Cancer 14(8):717–723. https://doi.org/10.1111/1759-7714.14799
doi: 10.1111/1759-7714.14799
pubmed: 36691325
pmcid: 10008675
Rath J, Moser B, Zimprich F (2023) Thymectomy in myasthenia gravis. Curr Opin Neurol 36(5):416–423. https://doi.org/10.1097/WCO.0000000000001189
doi: 10.1097/WCO.0000000000001189
pubmed: 37639450
Jaretzki A, Steinglass K, Sonett J (2004) Thymectomy in the management of myasthenia gravis. Semin Neurol 24:49–62
doi: 10.1055/s-2004-829596
pubmed: 15229792
Tomulescu V, Sgarbura O, Stanescu C, Valciu C, Campeanu A, Herlea V, Popescu I (2011) Ten-year results of thoracoscopic unilateral extended thymectomy performed in nonthymomatous myasthenia gravis. Ann Surg. https://doi.org/10.1097/SLA.0b013e31823686f6
doi: 10.1097/SLA.0b013e31823686f6
pubmed: 22005151
Pompeo E, Tacconi F, Massa R, Mineo D, Nahmias S, Mineo TC (2009) Long-term outcome of thoracoscopic extended thymectomy for nonthymomatous myasthenia gravis. Eur J Cardiothorac Surg 36(1):164–169. https://doi.org/10.1016/j.ejcts.2009.02.021
doi: 10.1016/j.ejcts.2009.02.021
pubmed: 19339195
Levinson AI, Song D, Gaulton G, Zheng Y (2004) The intrathymic pathogenesis of myasthenia gravis. Clin Dev Immunol 11:215–220
pubmed: 15559366
pmcid: 2486327
Gronseth GS, Barohn RJ (2000) Practice parameter: thymectomy for autoimmune myasthenia gravis (an evidence-based review): report of the quality standards subcommittee of the American academy of neurology. Neurology 55(7–15):11
Toyka KV, Gold R (2007) Treatment of myasthenia gravis. Schweiz Arch Neurol Psychiatr 158:309–321
doi: 10.4414/sanp.2007.01882
Romano G, Zirafa CC, Ceccarelli I, Guida M, Davini F, Maestri M, Morganti R, Ricciardi R, Hung Key T, Melfi F (2021) Robotic thymectomy for thymoma in patients with myasthenia gravis: neurological and oncological 0utcomes. Eur J Cardiothorac Surg 60(4):890–895. https://doi.org/10.1093/ejcts/ezab253
doi: 10.1093/ejcts/ezab253
pubmed: 34263301
Jiao P, Wu F, Wu J, Sun Y, Tian W, Yu H, Huang C, Li D, Wu Q, Ma C, Tong H (2023) Surgical safety analysis and clinical experience sharing of myasthenia gravis patients aged 65 and over. Thorac Cancer. 14(8):717–723. https://doi.org/10.1111/1759-7714.14799
doi: 10.1111/1759-7714.14799
pubmed: 36691325
pmcid: 10008675
Otsuka R, Ueda K, Tanaka T, Murakami J, Hayashi M, Hamano K (2019) Who will benefit from thymectomy for myasthenia gravis? Is there any role for this procedure in elderly patients? Ann Transl Med 7(1):4. https://doi.org/10.21037/atm.2018.11.66.
doi: 10.21037/atm.2018.11.66.
pubmed: 30788351
pmcid: 6351377
Cunha S, Faustino P, Jorge A, Graça LL, Almendra L, Matos A, Negrão L, Pancas R (2024) The impact of thymectomy in thymomatous and nonthymomatous myasthenia gravis—the experience of a tertiary center. Port J Card Thorac Vasc Surg 30(4):31–38. https://doi.org/10.48729/pjctvs.328
doi: 10.48729/pjctvs.328
pubmed: 38345885
Tian W, Yu H, Sun Y, He J, Wu Q, Ma C, Jiao P, Huang C, Li D, Tong H (2024) Thymoma negatively affects the neurological outcome of myasthenia gravis after thymectomy: a propensity score matching study. J Cardiothorac Surg 19(1):37. https://doi.org/10.1186/s13019-024-02511-6
doi: 10.1186/s13019-024-02511-6
pubmed: 38297367
pmcid: 10829313
Salahoru P, Grigorescu C, Hinganu MV, Lunguleac T, Halip AI, Hinganu D (2024) Thymus surgery prospectives and perspectives in myasthenia gravis. J Pers Med 14(3):241. https://doi.org/10.3390/jpm14030241.
doi: 10.3390/jpm14030241.
pubmed: 38540983
pmcid: 10971336
Ismail M, Swierzy M, Rückert RI, Rückert JC (2014) Robotic thymectomy for myasthenia gravis. Thorac Surg Clin 24(2):189–195. https://doi.org/10.1016/j.thorsurg.2014.02.012
doi: 10.1016/j.thorsurg.2014.02.012
pubmed: 24780423
Nawojowska A, Mendes S, Cabral D, Rodrigues C, Antunes M, Alvoeiro M, Torres C, Calado T, Felix F (2024) Results of minimally invasive vats thymectomy in miastenia gravis patients compared with more invasive approaches—10-year experience in a single center. Port J Card Thorac Vasc Surg 31(1):23–28. https://doi.org/10.48729/pjctvs.345.PMID:38743523
doi: 10.48729/pjctvs.345.PMID:38743523
pubmed: 38743523
Petroncini M, Solli P, Brandolini J, Lai G, Antonacci F, Garelli E, Kawamukai K, Forti Parri SN, Bonfanti B, Dolci G, Bertoglio P (2023) Early postoperative results after thymectomy for thymic cancer: a single-institution experience. World J Surg 47(8):1978–1985. https://doi.org/10.1007/s00268-023-06996-5
doi: 10.1007/s00268-023-06996-5
pubmed: 37079104
pmcid: 10310559
Menghesha H, Schroeter M, Nelke C, Ruck T, Schlachtenberger G, Welskop C, Camo A, Heldwein M, Bennink G, Wahlers T, Bölükbas S, Doerr F, Hekmat K (2023) The impact of thymectomy in subgroups of myasthenia gravis patients: a single center longitudinal observation. Neurol Res Pract 5(1):24. https://doi.org/10.1186/s42466-023-00252-w.
doi: 10.1186/s42466-023-00252-w.
pubmed: 37316910
pmcid: 10268481
Blalock A et al (1941) The treatment of myasthenia gravis by removal of the thymus gland: preliminary report. J Am Med Assoc 117(18):1529–1533
doi: 10.1001/jama.1941.02820440037009