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Az unilateralis videoasszisztált torakoszkópos thymomaeltávolítás javallata, korai és középtávú eredményei

Unilateral video-assisted thoracoscopic thymoma resection – Indications, early and mid-term results

Magyar Sebészet
Authors: József Kas, Levente Bogyó, Csaba Fehér, Áron Ghimessy, Balázs Gieszer, Luca Karskó, Lóránt Kecskés, Viktor Lungu, László Mészáros, Ágoston Pataki, Péter Radetzky, Róbert Szegedi, Bernadett Tallósy, Klári Török, Attila Vágvölgyi, János Fillinger, Tünde Harkó, Ibolya Soltész, Erika Tóth, Csilla Rózsa, Jenő Elek, Erna Ganovszky, László Agócs, Ferenc Rényi-Vámos, and Ákos Kocsis

Introduction

Thymoma is the most common tumour of the anterior mediastinum. Video-Assisted Thoracic Surgery technique of thymoma resection is spreading world-wide, but the thoracoscopic method is still contentious in many ways. Authors evaluate the early and mid-term results of a 17 years period of VATS unilateral approach at 2 Hungarian thoracic surgical centers.

Method

Depending on the anatomical situation of the thymoma, we performed thymectomy, or partial thymectomy (thymomectomy) for the Masaoka–Koga I–II–III stage thymoma from the right or left side through 2 or 3 intercostal ports. We managed the operations with ultrasonic dissector and electrocauter. By using international standards we evaluated perioperative morbidity, mid-term oncological results and clinical symptoms of myasthenia.

Results

23 of the 54 patients were man, 31 were woman, the average age was 58 (26–79) years, 23 of them had myasthenia. The conversion rate was 11,5% (7/61). The average operation time was 84 (39–150) minutes. The average hospitalisation time was 5.5 (3–19) days. The average size of the thymomas was 46 (18–90) mm. The histology resulted thymoma type A in 2 cases, AB in 19 cases, B1/2/3 in 11/11/1 cases, mixed B in 10 cases. The examination of the resection line was R0/1/2 in 42/11/1 cases. The Masaoka–Koga stages were: I (17), IIA (28), IIB (2), III (7). There was 25 thymomectomies, and 29 thymectomies. In seven cases there were extension of the operation to the pericardium (2), to the lung (2), to the phrenic nerve (6), and to innominate vein (1). The in-hospital mortality over 30 day was in 1 case (1.85%). The morbidity was 11/54 (20.4%). The average follow-up time was 62.56 (5–198) months. In the group with myasthenia the effectivity of the operation was 18/21 (85.7%), including complete remission of 5/21 (23.8%). Post-thymectomy myasthenia gravis developed in 2/31 cases (6.5%). The average 5 years survival was 100%, tumour-free 5 years survival was 96%.

Conclusions

The higher proportion of the thymomectomy in the early results, higher conversion rate and lower R0 proportion might be in connection with the attitude of the surgeons, with the learning curve and with the limitations of the unilateral method. After a longer follow-up time late results may become more real and comparable. Instead of unilateral VATS technique we have changed to the subxyphoideal approach of VATS because of its better visualisation.

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Orvosi Hetilap
Authors: , Budapest, Üllői út 78., 1082, Csilla András, Péter Bartek, István Battyáni, János Bezsilla, György Bodoky, Barna Bogner, Attila Bursics, Tibor Csőszi, László Damjanovich, Magdolna Dank, Zsófia Dankovics, Pál Ákos Deák, Kristóf Dede, Attila Doros, Ibolyka Dudás, Tamás Györke, Oszkár Hahn, Erika Hartmann, Erika Hitre, Zsolt Horváth, Marianna Imre, Károly Kalmár Nagy, Zsolt Káposztás, László Kóbori, Péter Kupcsulik, László Landherr, Zoltán Lóderer, László Mangel, Zoltán Máthé, Tamás Mersich, Klára Mezei, Elemér Mohos, Attila Oláh, Péter Pajor, András Palkó, Zsuzsanna Pápai, András Papp, Mihály Patyánik, András Petri, János Révész, Ágnes Ruzsa, Krisztina Schlachter, László Sikorszki, István Sipőcz, Eszter Székely, Attila Szijártó, László Torday, Lajos Barna Tóth, Edit Dósa, László Harsányi, Gábor István, György Lázár, József Lövey, Zsuzsa Schaff, Ákos Szűcs, and András Vereczkei
Open access

A hepatocellularis carcinoma komplex kezelése.

Konszenzuskonferencia, Budapest, 2021. április 24.

Complex management of hepatocellular carcinoma.

Consensus Conference, Budapest, April 24, 2021
Orvosi Hetilap
Author: Magyar Hepato-Pancreatico-Biliaris (HPB) Kutatócsoport 1
Open access