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胸腺切除术加全胸腺切除术与单纯胸腺切除术治疗无重症肌无力的早期胸腺瘤:欧洲胸外科 ...

已有 98 次阅读2021-5-25 14:47 |个人分类:TET学习|系统分类:医学科学| 胸腺瘤, 重症肌无力

胸腺切除术加全胸腺切除术与单纯胸腺切除术治疗无重症肌无力的早期胸腺瘤:欧洲胸外科医师协会胸腺工作组研究
Thymomectomy plus total thymectomy versus simple thymomectomy for early-stage thymoma without myasthenia gravis: a European Society of Thoracic Surgeons Thymic Working Group Study

目的:切除胸腺肿瘤,包括切除肿瘤和胸腺(胸腺瘤胸腺切除术; TT)是一种选择的方法,并在大多数相关文献中推荐使用。然而,近年来,一些作者建议从肿瘤学角度出发,对于没有重症肌无力(MG)(非MG)的早期胸腺瘤患者,从肿瘤学角度看,切除肿瘤 (单纯胸腺瘤切除术; ST)可能就足够了。我们研究的目的是使用欧洲胸外科医师协会胸腺数据库比较非MG早期胸腺瘤中ST与TT的短期和长期结局。
方法:本研究共纳入了498例非MG病理性I期胸腺瘤患者。接受根治性手术的498例患者中有466例(占93.6%)进行了TT检查; ST在32(6.4%)中完成。比较切除的完整性,并发症发生率,30天死亡率,总体复发率和无复发率。我们通过手术方法(ST vs TT)进行了粗略和倾向评分调整后的比较。
结果:TT显示出与ST相同的术后并发症发生率,30天死亡率和术后停留时间。 TT组的5年总生存率为89%,ST组为55%。 TT组的5年无复发率分别为96%和ST组的79%。
结论:TT的早期无MG胸腺瘤的患者比ST的患者表现出更好的复发自由度,且术后发病率没有增加。
关键词:胸腺切除术;复发;生存;胸腺切除术;胸腺瘤;胸腺切除术;胸腺瘤胸腺切除术

Objectives: Resection of thymic tumours including the removal of both the tumour and the thymus gland (thymothymectomy; TT) is the procedure of choice and is recommended in most relevant articles in the literature. Nevertheless, in recent years, some authors have suggested that resection of the tumour (simple thymomectomy; ST) may suffice from an oncological standpoint in patients with early-stage thymoma who do not have myasthenia gravis (MG) (non-MG). The goal of our study was to compare the short- and long-term outcomes of ST versus TT in non-MG early-stage thymomas using the European Society of Thoracic Surgeons thymic database.
Methods: A total of 498 non-MG patients with pathological stage I thymoma were included in the study. TT was performed in 466 (93.6%) of 498 patients who had surgery with curative intent; ST was done in 32 (6.4%). The completeness of resection, the rate of complications, the 30-day mortality, the overall recurrence and the freedom from recurrence were compared. We performed crude and propensity score-adjusted comparisons by surgical approach (ST vs TT).
Results: TT showed the same rate of postoperative complications, 30-day mortality and postoperative length of stay as ST. The 5-year overall survival rate was 89% in the TT group and 55% in the ST group. The 5-year freedom from recurrence was 96% in the TT group and 79% in the ST group.
Conclusion: Patients with early-stage thymoma without MG who have a TT show significantly better freedom from recurrence than those who have an ST, without an increase in postoperative morbidity rate.
Keywords: Extended thymectomy; Recurrence; Survival; Thymectomy; Thymoma; Thymomectomy; Thymothymomectomy.

Guerrera F, Falcoz PE, Moser B, van Raemdonck D, Bille' A, Toker A, Spaggiari L, Ampollini L, Filippini C, Thomas PA, Verdonck B, Mendogni P, Aigner C, Voltolini L, Novoa N, Patella M, Mantovani S, Bravio IG, Zisis C, Guirao A, Londero F, Congregado M, Rocco G, Du Pont B, Martucci N, Esch M, Brunelli A, Detterbeck FC, Venuta F, Weder W, Ruffini E; European Society of Thoracic Surgeons (ESTS) Thymic Working Group Participating Centers, Klepetko W, Olland A, Du Pont B, Nonaka D, Ozkan B, Loiacono G, Braggio C, Filosso PL, Brioude G, van Schil P, Nosotti M, Valdivia D, Bongiolatti S, Inci I, Dimitra R, Sànchez D, Grossi W, Moreno-Merino S, Teschner M. Thymomectomy plus total thymectomy versus simple thymomectomy for early-stage thymoma without myasthenia gravis: a European Society of Thoracic Surgeons Thymic Working Group Study. Eur J Cardiothorac Surg. 2021 May 23:ezab224. doi: 10.1093/ejcts/ezab224. Epub ahead of print. PMID: 34023891.

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