Robotic-Extended Rethymectomy for Refractory Myasthenia Gravis: A Case Series

• Published in: Seminars in thoracic and cardiovascular surgery Vol. 32; no. 3; pp. 593 - 602
• Main Authors: Li, Feng, Li, Zhongmin, Takahashi, Reona, Ioannis, Anagnostopoulos, Ismail, Mahmoud, Meisel, Andreas, Rueckert, Jens-C.
• Format: Journal Article
• Language: English
• Published: Elsevier Inc 01.01.2020
• Subjects: Clinical outcome; Refractory myasthenia gravis; Robotic-extended rethymectomy; Surgical decision making; VATS; Robotic-extended rethymectomy; TX; Surgical decision making; IVIg; PLEX; ITMIG; Clinical outcome; CT; AChR; MGFA-PIS; NA; Refractory myasthenia gravis; MG; MGTX; Anti-AChR Ab; WHO
• ISSN: 1043-0679; 1532-9488; 1532-9488
• DOI: 10.1053/j.semtcvs.2019.10.016

To assess the safety and efficacy of robotic-extended rethymectomy in selected refractory myasthenia gravis (MG) patients with suspected residual thymic tissue. Robotic-extended rethymectomy was performed in 6 MG patients with seropositive acetylcholine receptors (AChR) antibody who had undergone a previous thymectomy (1 cervicotomy, 2 video-assisted thoracoscopic surgeries, and 3 sternotomies). The median observation time before robotic rethymectomy was 108 (24–171) months. The main outcomes were perioperative morbidity, mortality, conversion to open surgery, and clinical outcomes according to the Myasthenia Gravis Foundation of America Post-Intervention Status (MGFA-PIS). Before rethymectomy, all patients required immunosuppressants and 5 patients (83.3%) required intravenous immune globulin and/or plasma exchange to control the symptoms. The median specimen weight was 24.5 (14–144) g after rethymectomy, and residual thymic tissue was found in 5 patients (83.3%). No conversion to open surgery or perioperative morbidity and mortality was observed. With a median follow-up time of 46.5 (13–155) months, 3 patients (50%) achieved “improved” and 3 (50%) were “unchanged” according to the MGFA-PIS. Compared with preoperative use, the median daily dose of corticosteroids statistically decreased (25 [7.5–60] vs 0 [0–5] mg, P = 0.002) without significant change in azathioprine use (100 [0–200] vs 50 [0–150] mg, P = 0.360). AChR antibody positive MG patients with a treatment refractory long-term course after thymectomy might have remaining thymic tissue with the 2 commonly associated thymus pathologies, thymoma, and follicular hyperplasia. Robotic-extended rethymectomy might be considered as a safe and beneficial treatment option in these patients. [Display omitted]