A Comparative Study On Clinical Outcome Of Video-assisted Thoracoscopic Surgery(VATS) Extended Thymectomy For Myasthenia Gravis Via Subxiphoid And Right Thoracic Approach

Objective:To compare Perioperative outcomes and short-term effects of extended thymectomy for myasthenia gravis(MG)treated by subxiphoid and right thoracic approach video-assisted thoracoscopic surgery(VATS),and to explore the application value of the subxiphoid approach in thoracic surgeryMethods:From June 2013 to March 2018,131 myasthenia gravis patients with or without thymoma underwent thoracoscopic extended thymectomy at our hospital.Among them,68 patients were operated via the subxiphoid approach and the other 63 via the conventional right side unilateral approach.Clinical date were compared between the two groups.Clinical outcome was assessed according to the classification system proposed by the Myasthenia Gravis Foundation of America(MGFA).Results:No significant differences were found in blood lose during operation,rate of conversion to thoracotomy,postoperative delayed extubation,postoperative crisis,postoperative thoracotomy for hemostasis,re-tracheal intubation after operation,postoperative hospital stay,postoperative complications among the two groups(p > 0.05).Compared with the right thoracic approach,the duration of the procedure via subxiphoid approach was significantly shorter(139.00 ± 34.56 min VS 152.14 ± 32.36 min,p = 0.035),Pain scores on postoperative days 1,3,and 7 were significantly higher in patients who underwent right thoracic approach compared with those who underwent subxiphoid approach(p < 0.001,p < 0.001,and p = 0.03,respectively).There were no serious complications and perioperative mortality in the whole group.A total of 112 patients with myasthenia gravis were followed up after thymectomy for a median time of 30 months(range,13~56 months).Lost to follow up 9 cases.3 patients died during this period.The subxiphoid approach group reported higher the rates of complete stable remission(CSR)and effective treatmen of MG than the right-thoracic approach group,although these differences were not statistically significan(Z =-0.484,P = 0.627).Conclusion:Both subxiphoid and right thoracic approaches were safe and feasible for the treatment of MG,and the effect was comparable.Among them,the subxiphoid approach could greatly reduce the postoperative pain of MG patients and shorten the operation time,which makes up for the deficiency of conventional right thoracic approach to a certain extentwhich was worthy of clinical promotion.