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

Florit Marcuse; Janneke G.J. Hoeijmakers; Monique Hochstenbag; Myrurgia Abdul Hamid; Marlies Keijzers; Marina Mané-Damas; Pilar Martinez-Martinez; Jan Verschuuren; Jan Kuks; Roy Beekman; Anneke J. van der Kooi; Pieter van Doorn; Michael van Es; Jos J.G. Maessen; Marc H.V. De Baets

doi:10.1016/j.nmd.2023.03.005

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

Florit Marcuse^*
, Janneke G.J. Hoeijmakers
, Monique Hochstenbag
, Myrurgia Abdul Hamid
, Marlies Keijzers
, Marina Mané-Damas
, Pilar Martinez-Martinez
, Jan Verschuuren
, Jan Kuks
, Roy Beekman
, Anneke J. van der Kooi
, Pieter van Doorn
, Michael van Es
, Jos J.G. Maessen
, Marc H.V. De Baets

^*Corresponding author for this work

Neurology

Maastricht University
Leiden University Medical Centre
University Medical Centre Groningen
Zuyderland Medical Center (Sittard-Geleen)
Amsterdam UMC

Research output: Contribution to journal › Article › Academic › peer-review

12 Citations (Scopus)

123 Downloads (Pure)

Abstract

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.

Original language	English
Pages (from-to)	417-424
Number of pages	8
Journal	Neuromuscular Disorders
Volume	33
Issue number	5
DOIs	https://doi.org/10.1016/j.nmd.2023.03.005
Publication status	Published - May 2023

Bibliographical note

Disclosures
Janneke G.J. Hoeijmakers reports a grant from the Prinses Beatrix Spierfonds (W.OK17–09), outside the submitted work.

Anneke van der Kooi reports grants from CSL Behring and Prinses Beatrix Spierfonds, outside the submitted work.

Pilar Martinez-Martinez reports grants from NIH, 5U54NS11054-02 co-investigator, 2021–2023. Interreg VA EMR program (EURLIPIDS, EMR23), co-investigator, 2019-2022. Additionally PMM has investigator initiated grants with Apellis and Argnex.outside of the submitted work.

Publisher Copyright: © 2023 The Author(s)

Access to Document

10.1016/j.nmd.2023.03.005Licence: CC BY

1-s2.0-S0960896623000718-mainFinal published version, 1.33 MBLicence: CC BY

Cite this

Marcuse, F., Hoeijmakers, J. G. J., Hochstenbag, M., Hamid, M. A., Keijzers, M., Mané-Damas, M., Martinez-Martinez, P., Verschuuren, J., Kuks, J., Beekman, R., van der Kooi, A. J., van Doorn, P., van Es, M., Maessen, J. J. G., & De Baets, M. H. V. (2023). Outcomes after robotic thymectomy in nonthymomatous versus thymomatous patients with acetylcholine-receptor-antibody-associated myasthenia gravis. Neuromuscular Disorders, 33(5), 417-424. https://doi.org/10.1016/j.nmd.2023.03.005

@article{8a0497a58a97467babf37112aa9e2aa9,

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

abstract = "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{\textregistered} 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.",

author = "Florit Marcuse and Hoeijmakers, \{Janneke G.J.\} and Monique Hochstenbag and Hamid, \{Myrurgia Abdul\} and Marlies Keijzers and Marina Man{\'e}-Damas and Pilar Martinez-Martinez and Jan Verschuuren and Jan Kuks and Roy Beekman and \{van der Kooi\}, \{Anneke J.\} and \{van Doorn\}, Pieter and \{van Es\}, Michael and Maessen, \{Jos J.G.\} and \{De Baets\}, \{Marc H.V.\}",

note = "Disclosures Janneke G.J. Hoeijmakers reports a grant from the Prinses Beatrix Spierfonds (W.OK17{\textendash}09), outside the submitted work. Anneke van der Kooi reports grants from CSL Behring and Prinses Beatrix Spierfonds, outside the submitted work. Pilar Martinez-Martinez reports grants from NIH, 5U54NS11054-02 co-investigator, 2021{\textendash}2023. Interreg VA EMR program (EURLIPIDS, EMR23), co-investigator, 2019-2022. Additionally PMM has investigator initiated grants with Apellis and Argnex.outside of the submitted work. Publisher Copyright: {\textcopyright} 2023 The Author(s)",

year = "2023",

month = may,

doi = "10.1016/j.nmd.2023.03.005",

language = "English",

volume = "33",

pages = "417--424",

journal = "Neuromuscular Disorders",

issn = "0960-8966",

publisher = "Elsevier Ltd.",

number = "5",

}

Marcuse, F, Hoeijmakers, JGJ, Hochstenbag, M, Hamid, MA, Keijzers, M, Mané-Damas, M, Martinez-Martinez, P, Verschuuren, J, Kuks, J, Beekman, R, van der Kooi, AJ, van Doorn, P, van Es, M, Maessen, JJG & De Baets, MHV 2023, 'Outcomes after robotic thymectomy in nonthymomatous versus thymomatous patients with acetylcholine-receptor-antibody-associated myasthenia gravis', Neuromuscular Disorders, vol. 33, no. 5, pp. 417-424. https://doi.org/10.1016/j.nmd.2023.03.005

TY - JOUR

T1 - Outcomes after robotic thymectomy in nonthymomatous versus thymomatous patients with acetylcholine-receptor-antibody-associated myasthenia gravis

AU - Marcuse, Florit

AU - Hoeijmakers, Janneke G.J.

AU - Hochstenbag, Monique

AU - Hamid, Myrurgia Abdul

AU - Keijzers, Marlies

AU - Mané-Damas, Marina

AU - Martinez-Martinez, Pilar

AU - Verschuuren, Jan

AU - Kuks, Jan

AU - Beekman, Roy

AU - van der Kooi, Anneke J.

AU - van Doorn, Pieter

AU - van Es, Michael

AU - Maessen, Jos J.G.

AU - De Baets, Marc H.V.

N1 - Disclosures Janneke G.J. Hoeijmakers reports a grant from the Prinses Beatrix Spierfonds (W.OK17–09), outside the submitted work. Anneke van der Kooi reports grants from CSL Behring and Prinses Beatrix Spierfonds, outside the submitted work. Pilar Martinez-Martinez reports grants from NIH, 5U54NS11054-02 co-investigator, 2021–2023. Interreg VA EMR program (EURLIPIDS, EMR23), co-investigator, 2019-2022. Additionally PMM has investigator initiated grants with Apellis and Argnex.outside of the submitted work. Publisher Copyright: © 2023 The Author(s)

PY - 2023/5

Y1 - 2023/5

N2 - 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.

AB - 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.

UR - https://www.scopus.com/pages/publications/85152682485

U2 - 10.1016/j.nmd.2023.03.005

DO - 10.1016/j.nmd.2023.03.005

M3 - Article

C2 - 37037051

AN - SCOPUS:85152682485

SN - 0960-8966

VL - 33

SP - 417

EP - 424

JO - Neuromuscular Disorders

JF - Neuromuscular Disorders

IS - 5

ER -

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

Abstract

Bibliographical note

Access to Document

Other files and links

Fingerprint

Cite this