Subxiphoid and subcostal thoracoscopic surgical approach for thymectomy
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and Other Interventional Techniques
Subxiphoid and subcostal thoracoscopic surgical approach for thymectomy Xiaofeng Chen1 · Qinyun Ma1 · Xuan Wang1 · An Wang1 · Dayu Huang1 Received: 22 April 2020 / Accepted: 16 September 2020 © Springer Science+Business Media, LLC, part of Springer Nature 2020
Abstract Background The continuous evolvement of minimally invasive thymectomy over the last decades has potential advantages over trans-sternal thymectomy with similar oncologic outcomes of thymoma and complete remission for myasthenia gravis patients. A variety of different minimally invasive approaches have been described previously. The aim of this article is to present our subxiphoid and subcostal approaches in thymectomy for patients with myasthenia gravis and thymomas and to investigate the early surgical outcomes of these patients. Methods A retrospective analysis was performed of 95 patients who underwent thymectomy via a subxiphoid and subcostal approach for MG and/or thymoma at our department during the period of 2015 to 2017. The clinical characteristics and early surgical outcomes of these patients were reviewed and analyzed. Results Complete thymectomy and extended thymectomy was accomplished through the subxiphoid and subcostal approach in 93 of the 95 (97.9%) patients. Two patients (3.2%) required conversion to sternotomy for the invasion of a thymoma. The mean operative time was 109 min (range 70–170 min), with the mean estimated blood loss of 47 ml (range 20–350 ml). Postoperative complications included two cases of myasthenic crisis: one case of pleural effusion and one case of wound infection. In a mean follow-up of 31 months no patients showed recurrence of the tumor. In 41 MG patients followed up for 31 months, the improvement rate was 87.8% and the rate of complete remission was 29.3%. Conclusion Subxiphoid and subcostal thoracoscopic thymectomy may be a safe and feasible approach for treating MG and anterior mediastinal tumors Keywords Thymectomy · Subxiphoid · Thoracoscopic · Thymoma · Myasthenia gravis Thymectomy is most commonly considered to be an important part of the treatment of thymoma and myasthenia gravis (MG). A complete en-bloc thymectomy is crucial for tumor resection and complete remission of MG. The minimally invasive thymectomy has been performed frequently for the treatment of non-thymomatous MG [1], while a median sternotomy has traditionally been the preferred approach of thymectomy for patients with thymoma [2]. With benefits over trans-sternal thymectomy including better cosmetic
Xiaofeng Chen and Qinyun Ma have contributed equally to this work * Dayu Huang [email protected] 1
Department of Cardiothoracic Surgery, Huashan Hospital, Fudan University, 12 Wulumuqi Zhong Road, Shanghai 200040, People’s Republic of China
results, less trauma, and fewer complications, minimally invasive thymectomy becomes the preferred operation in the treatment of thymoma and MG [3]. Several minimally invasive approaches have been applied in thymectomy, such as transcervical approach
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