Outcomes after robotic thymectomy in nonthymomatous versus thymomatous patients with acetylcholine-receptor-antibody-associated myasthenia gravis

•Robotic thymectomy is safe and feasible in patients with myasthenia gravis.•The majority of the patients (82.4%) improved in MG manifestations after robotic thymectomy.•MG remission was observed in 47.8% of the patients after thymectomy (mean: 26.2 months).•Thymomatous patients had more frequently...

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Published in:	Neuromuscular disorders : NMD Vol. 33; no. 5; pp. 417 - 424
Main Authors:	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.
Format:	Journal Article
Language:	English
Published:	England Elsevier B.V 01-05-2023
Subjects:	Acetylcholine Autoantibodies Follow-up Humans Myasthenia gravis Myasthenia Gravis - complications Myasthenia Gravis - surgery Receptors, Cholinergic Retrospective Studies Robotic Surgical Procedures - adverse effects Robotic thymectomy Thymectomy Thymomas Thymus Neoplasms - complications Treatment Outcome Thymomas Myasthenia gravis Robotic thymectomy Follow-up
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Summary:	•Robotic thymectomy is safe and feasible in patients with myasthenia gravis.•The majority of the patients (82.4%) improved in MG manifestations after robotic thymectomy.•MG remission was observed in 47.8% of the patients after thymectomy (mean: 26.2 months).•Thymomatous patients had more frequently complications compared to nonthymomatous patients. 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 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.
Bibliography:	ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 23
ISSN:	0960-8966 1873-2364
DOI:	10.1016/j.nmd.2023.03.005