long-term follow-up
Cameron P. Keating1, Yu Kong1, Valerie Tay2, Simon R. Knight3, Peter C. Clarke3, Gavin M. Wright1.
1Department of Cardiothoracic Surgery, St Vincent's Hospital, Melbourne, Australia, 2Department of Neurology, St Vincent's Hospital, Melbourne, Australia, 3Department of Thoracic Surgery, Austin Hospital, Melbourne, Australia.
OBJECTIVE:
Video-assisted thoracoscopic (VATS) thymectomy has been in practice for over a decade now in Australia. Our aim was to assess the long-term clinical outcomes using the Myasthenia Gravis Foundation of America (MGFA) post-intervention classification, with particular emphasis on ‘complete stable remission’ (CSR), in order to more validly compare results with other published series. We have included patients with thymoma because it is thought these patients have worse outcomes. Despite thoracoscopic thymectomy now being utilized in numerous centres around the world, controversy remains about whether remission rates are as good as the open ‘maximal’ approach.
METHODS:
A retrospective audit of consecutive patients with Myasthenia Gravis undergoing VATS thymectomy between October 1994 and December 2006 at two tertiary hospitals in Melbourne, Australia was undertaken. Patients were followed-up for a minimum of 12 months in order to assess clinical outcome using MGFA criteria. Data was collected from medical records and supplemented with telephone interviews.
RESULTS:
A total of 72 patients were followed-up (52 Female, 20 Male), with a median review time of 33 months (range 4-162). There were 55 non-thymoma (19 Normal, 36 Hyperplastic) and 17 thymomas. 3 patients (4.2%) were lost to follow-up. 2 patients died (2.8%) but not in the immediate post-operative period (10 and 12 months respectively). Gross outcomes for all patients were 64 improved (89%) and 40 asymptomatic (56%). These rates were similar in thymoma and non-thymoma groups. Of the 40 asymptomatic patients 28 (39% overall) were still on medications. CSR rates were 41.2% at 8 years for non-thymoma and 38% at 3 years for thymoma patients.
CONCLUSIONS:
The ‘complete stable remission’ rates for myasthenics with thymoma was not significantly different to those without, in contrast to previous reports. Though the number of thymomas were small there was a clear trend for earlier remission in this group. Overall, remission rates for both myasthenics with and without thymoma were similar to other reported series, both minimally invasive and open.
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