Subxiphoid and subcostal arch thoracoscopic versus unilateral thoracoscopic thymectomy for the treatment of thymic abnormalities with myasthenia gravis: A propensity-score matching study

Xunliang Yin; Sha Xue; Zhengwei Zhao; Shaoyi Cheng; Zheng Feng; Yize Guo; Tianyi Zhang; Jing Zhang; Yongan Zhou

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Subxiphoid and subcostal arch thoracoscopic versus unilateral thoracoscopic thymectomy for the treatment of thymic abnormalities with myasthenia gravis: A propensity-score matching study

VernacularTitle:胸腔镜剑突肋缘下与单侧胸腔镜胸腺扩大切除术治疗重症肌无力疗效对比的倾向性评分匹配分析
Author: Xunliang YIN ^{1
,

2} ; Sha XUE ^{1
,

2} ; Zhengwei ZHAO ^{1
,

2} ; Shaoyi CHENG ^{1
,

2} ; Zheng FENG ^{1
,

2} ; Yize GUO ^{1
,

2} ; Tianyi ZHANG ^{1
,

2} ; Jing ZHANG ^{1
,

2} ; Yongan ZHOU ^{1
,

2}
Author Information

1. Department of Thoracic Surgery, Tangdu Hospital, Air Force Military Medical University, Xi&rsquo
2. an, 710038, P.R.China
Publication Type:Journal Article
Keywords: Thymic tumor; video-assisted thoracic surgery; subxiphoid and subcostal arch; myasthenia gravis; propensity-score matching
From: Chinese Journal of Clinical Thoracic and Cardiovascular Surgery 2021;28(04):473-478
CountryChina
Language:Chinese
Abstract: Objective To compare clinical effects of extended thymectomy for the treatment of thymic abnormalities with myasthenia gravis (MG) between subxiphoid and subcostal arch thoracoscopic resection (SR) and the unilateral thoracoscopic resection (UR) by a propensity-score matching analysis. Methods We retrospectively analyzed the clinical data of 612 patients who presented with MG and were admitted to Tangdu Hospital of Air Force Military Medical University between December 2011 and December 2018. Of these patients, 520 patients underwent subxiphoid and subcostal arch thoracoscopic extended thymectomy (a SR group) and 92 unilateral thoracoscopic extended thymectomy (a UR group). Ninety-two patients in the SR group were matched with the UR group by propensity-score matching analysis. There were 52 males and 40 females with an average age of 26-70 (50.2±10.3) years in the SR group, and 47 males and 45 females with an average age of 20-73 (51.5±12.1) years in the UR group. The operation time, intraoperative blood loss, thoracic drainage time, postoperative hospital stay, thorough adipose tissue removal, postoperative remission of MG, patients’ satisfaction score, pain and complications were compared and analyzed between the two groups. Results All operations were accomplished successfully, without conversion to thoracotomy of the two groups. There were statistical differences between the two groups in operation time (46.2±19.5 min vs. 53.4±23.5 min), chest drainage duration (0 d vs. 3.4±1.2 d), hospital stay (2.9±1.9 d vs. 3.6±1.7 d), patients’ satisfaction score (7.9±2.1 points vs. 6.7±1.2 points) and pain scores (all P<0.05). There were no statistical differences between the two groups in intraoperative blood loss (52.2±12.7 mL vs. 51.2±10.3 mL), peripheral adipose tissue removal (8.1±0.6 vs. 7.9±0.9), remission rate of MG (89.1% vs. 85.9%) and rate of postoperative complications (10.9% vs. 6.5%) (all P>0.05). Conclusion Subxiphoid and subcostal arch thoracoscopic extended thymectomy is a safe and feasible minimally invasive procedure for the management of MG with thymic abnormalities.