Outcomes after robotic thymectomy in nonthymomatous versus thymomatous patients with acetylcholine-receptor-antibody-associated myasthenia gravis
Marcuse, Florit; Hoeijmakers, Janneke G.J.; Hochstenbag, Monique; Hamid, Myrurgia Abdul; Keijzers, Marlies; Mané-Damas, Marina; Martinez-Martinez, Pilar; Verschuuren, Jan; Kuks, Jan; Beekman, Roy; van der Kooi, Anneke J.; van Doorn, Pieter; van Es, Michael; Maessen, Jos J.G.; De Baets, Marc H.V.
(2023) Neuromuscular Disorders, volume 33, issue 5, pp. 417 - 424
(Article)
Abstract
The aim of this study was to investigate the surgical and long-term neurological outcomes of patients with acetylcholine-receptor-antibody-associated myasthenia gravis (AChR-MG) who underwent robotic thymectomy (RATS). We retrospectively analyzed the clinical-pathological data of all patients with AChR-MG who underwent RATS using the DaVinci® Robotic System at the MUMC+ between April
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2004 and December 2018. Follow-up data were collected from 60 referring Dutch hospitals. In total, 230 myasthenic patients including 76 patients with a thymoma (33.0%) were enrolled in this study. Mean follow-up time, procedure time and hospitalization were, respectively 65.7 ± 43.1 months, 111±52.5 min and 3.3 ± 2.2 days. Thymomatous patients had significantly more frequently and more severe complications than nonthymomatous patients (18.4% vs. 3.9%, p<0.001). Follow up data was available in 71.7% of the included patients. The Myasthenia Gravis Foundation of America postintervention score showed any kind of improvement of MG-symptoms after RATS in 82.4% of the patients. Complete stable remission (CSR) or pharmacological remission (PR) of MG was observed in 8.4% and 39.4% of the patients, respectively. Mean time till CSR/PR remission after thymectomy was 26.2 ± 29.2 months. No statistical difference was found in remission or improvement in MGFA scale between thymomatous and nonthymomatous patients. RATS is safe and feasible in patients with MG. The majority of the patients (82.4%) improved after thymectomy. CSR and PR were observed in 8.4% and 39.4% of the patients, respectively, with a mean of 26.2 months after thymectomy. Thymomatous patients had more frequently and more severe complications compared to nonthymomatous patients.
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Keywords: Follow-up, Myasthenia gravis, Robotic thymectomy, Thymomas, Pediatrics, Perinatology, and Child Health, Neurology, Clinical Neurology, Genetics(clinical)
ISSN: 0960-8966
Publisher: Elsevier Limited
Note: Funding Information: Anneke van der Kooi reports grants from CSL Behring and Prinses Beatrix Spierfonds, outside the submitted work. Funding Information: Janneke G.J. Hoeijmakers reports a grant from the Prinses Beatrix Spierfonds (W.OK17–09), outside the submitted work. Funding Information: We are grateful to all participating departments in the 60 hospitals in the Netherlands who contributed to this study. Special thanks to all pulmonologists, thoracic surgeons and neurologists who decided to refer their patients for RATS to the MUMC+. We also like to thank all included patients for their participation and consent. Several authors of this publication are members of the Netherlands Neuromuscular Center (NL-NMD) and the European Reference Network for rare neuromuscular diseases EURO–NMD. MM-D is supported by a Kootstra fellowship. Publisher Copyright: © 2023 The Author(s)
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