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Year :2020
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Month :
July
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Volume :
9
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Issue :
3
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Page :
SO05 - SO08
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Video Assisted Thymectomy- A New Frontier in Myasthenia Gravis
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Correspondence Address :
ROHIT SHARMA, AMIY ARNAV, VARUN KUMAR AGARWAL,
Dr. Amiy Arnav,
Department of Surgical Oncology, Army Hospital Research and Referral, Delhi Cant-110010, India.
E-mail: arnavamiy@gmail.com
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Introduction: Introduction: Thymoma comprises 20% of all mediastinal neoplasms and 50% of all primary tumours in the anterior compartment. Thymic surgery has undergone a paradigm shift in approach from being transcervical to video assisted. Video assisted thymectomies in selected patients can decrease the inherent morbidities of a trans-sternal approach, while achieving similar therapeutic benefits.
Aim: To analyse the technical key points, morbidity and outcomes associated with video assisted thymectomy in early stage thymoma (Modified Masoaka stage I or II) with myasthenia gravis.
Materials and Methods: The present study was a retrospective observational analysis of 24 patients with thymoma and Myasthenia Gravis Foundation of America (MGFA) class II to IV myasthenia gravis who underwent video assisted thoracoscopic thymectomy in institution from May 2013 to May 2018. All patients with thymomas which on Contrast Enhanced Computed Tomography (CECT) did not show infiltration of the surrounding structures and were <5 cm were included. All patients were operated under General Anaesthesia (GA) with a single lumen tube with controlled CO2 pneumothorax with right or left thoracoscopic approach. Primary outcomes studied were immediate and delayed complications, completeness of resection and rate of conversion to open. Secondary outcome included intensity of treatment required for myasthenia gravis after two years of follow-up.
Results: In present study, 83.3% of the patients were male and 63% belonged to 20-40 years of age. Only 8% of the patients belonged to <20 years of age. Mean operative time was 164±10 minutes in Video-Assisted Thoracoscopic Surgery (VATS). Blood loss in VATS was 178±47 mL. Mean chest tube duration was only 3.2±0.67 days. Duration of stay in the hospital was on an average 3.4±1.45 days. Mean VAS pain scale for VATS patients was 3.5±1.08. Postoperative complication occurred in 8.3% of the patients. About 50% of the patients achieved complete remission of myasthenia gravis symptoms and were free of any treatment.
Conclusion: Management of thymoma with myasthenia gravis remains an evolving clinical undertaking which requires multidisciplinary approach. In carefully selected patients, minimally invasive techniques such as video assisted thymectomies have very low immediate or long term morbidity with excellent remission rates for myasthenia gravis.
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