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Subxiphoid and subcostal arch versus unilateral video-assisted thoracic surgery approaches to thymectomy for myasthenia gravis

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Abstract

Purpose

Thymectomy is an important treatment for myasthenia gravis (MG). We conducted this study to compare the clinical outcomes of the recently introduced subxiphoid and subcostal arch thymectomy (SASAT) approach with those of the standard unilateral video-assisted thoracoscopic surgery (VATS).

Methods

We analyzed, retrospectively, the perioperative, and long-term outcomes of 179 consecutive MG patients (age 18–65 years), who underwent SASAT or unilateral VATS-extended thymectomy between July, 2012 and May, 2019.

Results

All demographic and clinical characteristics were comparable in the two groups. The median surgical time, estimated blood loss, thoracotomy conversion rate, total and chest drainage, and complications did not differ significantly between the groups. The visual analog scale (VAS) score was significantly lower in the SASAT group. Complete stable remission (CSR) was achieved in a significantly larger proportion of the SASAT group patients and was significantly higher in women than in men. The Quantitative MG score was significantly lower in the SASAT group. Patients in the MG Foundation of America Clinical Classification groups I and II achieved better remission rates than those in groups III–V.

Conclusions

SASAT is a safe and feasible MG treatment, which may yield better outcomes than unilateral VATS and improve the quality of treatment.

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Funding

This work was supported by the National Nature Science Foundation of China (No. 81671905), Cultivation Plan for Scientific Research Projects of Dongguan People’s Hospital (No. K202031), and Dongguan Science and Technology of Social Development Program (No. 201950715001176). The authors had the freedom of investigation and full control of the study design, methods used, outcome parameters and results, analysis of data, and production of the written report.

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Author notes

  1. Yujiang Li, Zhenhui Huang, and Wohua Han contributed equally.

Authors and Affiliations

  1. Department of Thoracic and Cardiovascular Surgery, Huiqiao Medical Center, Nanfang Hospital, Southern Medical University, The First School of Clinical Medicine, Southern Medical University, No. 1838, Guangzhou Avenue North Road, Guangzhou, 510000, China

    Yujiang Li, Mongying Sun, Yali Liu & Xu Wu

  2. Department of Thoracic and Cardiovascular Surgery, Affiliated Dongguan People’s Hospital, Southern Medical University (Dongguan People’s Hospital), No. 3, South of Wandao Road, Wanjiang District, Dongguan, 523000, China

    Yujiang Li, Zhenhui Huang, Wohua Han, Jingquan Yuan, Ruiwen Xie, Guobiao Cheng, Xi’an Huang, Yuliang Guo & Jianping Zhou

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  1. Yujiang Li
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Correspondence to Xu Wu or Jianping Zhou.

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Li, Y., Huang, Z., Han, W. et al. Subxiphoid and subcostal arch versus unilateral video-assisted thoracic surgery approaches to thymectomy for myasthenia gravis. Surg Today 53, 12–21 (2023). https://doi.org/10.1007/s00595-022-02533-4

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  • DOI: https://doi.org/10.1007/s00595-022-02533-4

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