F-015
MINIMALLY INVASIVE SURGICAL APPROACHES FOR THE TREATMENT OF NON-THYMOMATOUS MYASTHENIA GRAVIS: A COMPARATIVE PROPENSITY-SCORE ADJUSTED MULTICENTRE STUDY Free

Objectives: Evidence of benefits of thymectomy by complete sternotomy in the treatment of non-thymomatous myasthenia gravis (MG) was recently proven by a multicentre randomized trial. Several recent papers proposed different minimally invasive surgical approaches for the treatment of MG and compared them with the classic complete sternotomy. Nevertheless, the best procedure is still matter of debate. The aim of our study is to compare clinical outcomes of the available minimally invasive approaches: cervicotomy with upper sternotomy (C-US), video-assisted (VATS) and robotic-assisted (RATS) thoracic surgery.

Methods: We conducted a retrospective analysis of 267 consecutive non-thymomatous MG-patients, operated in 2 European Thoracic Surgery Institutions between 1990 and 2015. Explored clinical outcome parameters were (1) remission rate, (2) improvement of Myasthenia Gravis Foundation of America (MGFA) clinical status and (3) reduction (<10 mg of prednisone) or suspension of steroids therapy. Crude and Propensity score (PS) adjusted comparisons by type of surgical approach C-US vs RATS/VATS were performed using logistic regression method. Missing data were multiple-imputed and combined estimates were obtained from 5 imputed datasets.

Results: Two-hundred and nine patients were available for the final analysis. Median age was 33 years (interquartile range 24-44) and 199 patients were female (72%). Two-hundred and twenty patients (82%) were operated by C-US, 47 (16%) by RATS and 4 (2%) by VATS. MGFA clinical-status improved in 89% (186/209) of the patients, a remission of symptoms (clinical or pharmacological) was observed in 42% (87/209) and 47% (32/68) suspend/reduce steroid treatment. Considered C-US as reference, we did not observe at PS-adjusted models a significant difference in terms of remission rate (RATS/VATS OR: 1.35, 95% CI 0.65–2.77, P=0.418), improvement of MGFA clinical-status (RATS/VATS OR: 0.58, 95% CI 0.18–1.93, P=0.378) and reduction/suspension of steroid treatment (RATS/VATS OR: 1.43, 95% CI 0.45–4.57, P=0.548).

Conclusions: Our results indicated that RATS/VATS had same clinical results as C-US. The choice of the optimal surgical approach should be tailored on the base of availability, desired aesthetic results and physicians and patient preferences.

Disclosure: No significant relationships.