Author of

• 10643

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  P1.07 - Poster Session 1 - Surgery (ID 184)

  • Event: WCLC 2013
  • Type: Poster Session
  • Track: Surgery
  • Presentations: 1
  • Moderators:
  • Coordinates: 10/28/2013, 09:30 - 16:30, Exhibit Hall, Ground Level

  • 10675

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    P1.07-032 - Experience of surgical treatment of myasthenia (ID 2181)

    09:30 - 09:30  |  Author(s): A. Kasatov
    • Abstract

    Background
    Background. Thymomas are the most common tumors of the anterior mediastinum. Clinical manifestations of thymomas depend on their endocrine activity, growth pattern and size. Non-invasive thymomas are mostly asymptomatic. According to different authors, more than 75% of thymomas are combined with myasthenia gravis. Myasthenia gravis affects people of working age, is characterized by a progressive course and often leads to disability. In the last decade, as a result of the active introduction of minimally invasive surgical techniques to the practice, the question of the choice of surgical approach between open access and endoscopic surgery remains to be open.

    Methods
    Methods. In the period 2002-2012 45 patients with tumor and hyperplasia of thymus were treated in Perm regional clinical hospital. Mean age was 43.9 years. Women of working age prevailed among the patients - 31 (68.8%). During examination hyperplasia of thymus was revealed in 15 patients, thymoma in 30 patients besides 5 of them had invasive malignant tumor growth. Among patients with hyperplasia of thymus (15 patients) the clinic of myasthenia was revealed in 9 cases (60%), 5 of them had generalized form and 4 – local form of myasthenia. In the group of patients with tumor of thymus (30 patients) myasthenia gravis was diagnosed in 26 of them, which amounted to 86.6%. Thus generalized form of myasthenia gravis was observed in 24 patients (92,3%), and its local forms were revealed only in 2 cases.

    Results
    Results. Surgical treatment was performed in 42 patients, that is 93.3%. In 3 patients surgical treatment wasn’t carried out due to the presence of severe comorbidity. Sternotomy and extended thymectomy was performed in 25 patients, thymectomy through thoracotomy was performed in 4 cases. Since 2008 endoscopy (VATS) started to be used for thymectomy (pic. 2A, pic.2B). It was carried out in 13 patients, but in 3 cases complementary (extra) minithoracotomy was required because of the intraoperatively diagnosed invasion of large vessels. Pic. 2 A Pic. 2 B General postoperative mortality was 4.5%. Two patients after VATS died. They had invasion of the tumor to the mediastinal great vessels and the endoscopic operation required a conversion to thoracotomy because of the massive intraoperational blood loss. The regression of neurological symptoms and the decrease of necessity of the anticholinesterase drugs were revealed in all the patients that were operated.

    Conclusion
    Conclusions.In spite of the technical capability for extended thymectomy and less traumatic rate of the endoscopic method we consider that a complete longitudinal sternotomy is better in cases of invasion of tumor to the mediastinal great vessels or in suspicion on presence of aberrant thymic tissue in the mediastinal and neck cellular spaces.