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Impact of the Surgical Approach to Thymectomy Upon Complete Stable Remission Rates in Myasthenia Gravis: A Meta-analysis

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dc.contributor.author Solis-Pazmino, Paola
dc.contributor.author Baiu, Ioana
dc.contributor.author Lincango-Naranjo, Eddy
dc.contributor.author Trope, Winston
dc.contributor.author Prokop, Larry
dc.contributor.author Ponce, Oscar J.
dc.contributor.author Shrager, Joseph B.
dc.date.accessioned 2021-05-18T21:44:15Z
dc.date.available 2021-05-18T21:44:15Z
dc.date.issued 2021
dc.identifier.uri https://hdl.handle.net/20.500.12866/9378
dc.description.abstract OBJECTIVES: To determine whether the available operative techniques for thymectomy in myasthenia gravis (MG) confer variable chances for achieving complete stable remission (CSR), we performed a meta-analysis of comparative studies of surgical approaches to thymectomy. METHODS: Meta-analysis of all studies providing comparative data on thymectomy approaches, with CSR reported and minimum 3 years mean follow-up. RESULTS: 12 cohort studies and one randomized clinical trial, containing 1598 patients, met entry criteria. At 3 years, CSR from MG was similar following VATS extended vs. both basic (RR 1.00, p=1.00, 95% CI 0.39-2.58) and extended (RR 0.96, p=0.74, CI: 0.72-1.27) transsternal approaches. CSR at 3 years was also similar following extended transsternal vs. combined transcervical-subxiphoid (RR 1.08, p=0.62, CI: 0.8-1.44) approaches. VATS extended approaches remained statistically equivalent to extended transsternal approaches through 9 years of follow-up (RR 1.51, p=0.05, CI: 0.99-2.30). The only significant difference in CSR rate between a traditional open and a minimally invasive approach was seen at 10 years when comparing the now-abandoned basic (non-sternum-lifting) transcervical approach and the extended transsternal approach (RR 0.4, p=0.01, CI: 0.2-0.8). CONCLUSIONS: A significant difference in the rate of CSR among various surgical approaches for thymectomy in MG was identified only at long-term follow-up, and only between what might be considered the most aggressive approach (extended transsternal thymectomy) and the least aggressive approach (basic transcervical thymectomy). Extended minimally invasive approaches appear to have equivalent CSR rates to extended transsternal approaches and are therefore appropriate in the hands of experienced surgeons en_US
dc.language.iso eng
dc.publisher Wolters Kluwer Health
dc.relation.ispartofseries Neurology
dc.rights info:eu-repo/semantics/restrictedAccess
dc.rights.uri https://creativecommons.org/licenses/by-nc-nd/4.0/deed.es
dc.subject Surgical Approach en_US
dc.subject Thymectomy Upon en_US
dc.subject Myasthenia Gravis en_US
dc.title Impact of the Surgical Approach to Thymectomy Upon Complete Stable Remission Rates in Myasthenia Gravis: A Meta-analysis en_US
dc.type info:eu-repo/semantics/article
dc.identifier.doi https://doi.org/10.1212/WNL.0000000000012153
dc.subject.ocde https://purl.org/pe-repo/ocde/ford#3.02.25
dc.relation.issn 1526-632X


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