Study On Comparison Of Different Thymectomy Surgeries

Background Thymic tumors are common primary neoplasms of the mediastinum in the normal population and myasthenia gravis (MG) is coexistent in approximately 30% of patients with thymic tumors. Thymic tumors not accompanied by myasthenia gravis is usually detected by routine examination. Thymectomy has been performed for several decades since Blalock and colleagues described a series of patients with MG with improvement after thymectomy and is considered to be an effective tactic for myasthenia gravis (MG) and early-stage thymic tumors. Thymectomy is an important component in the management of MG in patients with thymic tumor now. Recent reviews and proved its good effect. Traditional surgical with a sternotomy, has been the standard treatment. While mini-invasive surgical approaches including video-assisted thoracoscopic surgery (VATS) and surgical robotic surgery are popular in cardiothoracic surgery now, the excellence and effect of mini-invasive thymectomy are still in controversy. A number of published studies of thymectomy for MG reported that mini-invasive approaches are more advantageous because of shorter hospital stay and less pain. But there is no comparative study of a large sample so far. In this study, we compared several intraoperative and postoperative aspects among the three groups with different surgical approaches.Objective 1)To compare the resection areas of different approaches;2)to compare perioperative outcomes of patients with different surgical approaches;3) to compare long-term outcome of different approaches;4)to discuss the development trends of thymectomy.Methods 1) Choose patients who underwent thymectomy from January 2007 to December 2012 in our center and exclude unsuited ones.2) All patients are divided into Transsternal group, Thoracoscopic group and Surgical Robotic group. And each group is divided into 3 subgroups:Non-MG, Ocular MG and Generalized MG.3) Obtain clinical data and finish follow-up works.Results 1) The characteristics of the 187 patients are as follow:mean age of patient was 39.72±16.98 years,93 male patients and 94 female patients,2) Thoracoscopic group and Surgical Robotic group have shorter surgical durations and less intraoperative blood loss. Thoracoscopic group and Surgical Robotic group have fewer postoperative hospital days.3) There are no significant differences in other aspects including ICU stay, duration of mechanical ventilation and so on.4) Transsternal group and Surgical Robotic group have higher remission rates than Thoracoscopic group, but the gaps are not significant.Conclusions 1). Thoracoscopic surgery improves recovery and relieves pain greatly but has lower resection rate and worse operative views.2).Traditional surgery has higher resection rate and better operative views but brings much pain to patients.3) Combined with advantages of thoracoscopic approach and traditional approach, robotic surgery represents the development trends of thymectomy.