Ezel ERŞEN, Hasan Volkan KARA, Burcu KILIÇ, Mehlika İŞCAN, Akif TURNA, Kamil KAYNAK

Myastenik ve Non-Myastenik Timus Tümörlerinde Genişletilmiş Timektomi İşleminin Sonuçları

Amaç: Timik malignite nedeniyle genişletilmiş timektomi uyguladığımız hastaların sonuçlarını geriye dönük olarak inceleyerek, cerrahi tedavinin timus tümörü olan hastalarda terapotik etkilerini ortaya koymayı planladık. Materyal ve Metot: Kliniğimizde Ekim 2012-Ocak 2018 tarihleri arasında ardışık olarak genişletilmiş timektomi uyguladığımız timik maligniteli 29 hastanın sonuçları ayrıntılı olarak irdelendi. Olguların ameliyat öncesi, ameliyat sırası ve sonrasındaki takip değerleri kayıt edildi. Bulgular: Hastaların 13 tanesi erkek, 16 tanesi kadın idi. Ortalama yaş 41,4±17,7 olarak hesaplandı (9–75 yaş dağılımı). Olgularının 9 tanesine (%31) myastenia graves (MG) hastalığı eşlik etmekteydi. Ortalama FEV1 2678,17±954,5 ml ve ortalama FEV1 %94±19,8 ml olarak hesaplandı. Timektomi 20 hastada sternotomi ile uygulanırken, 9 hastada torakoskopik timektomi uygulandı. Ortalama operasyon süresi 137,9±31,8 dakika olarak hesaplanırken (Torakoskopi grubu 149,1±45,5 dakika, sternotomi grubu 134,1±26,5 dakika), ortalama peroperatif kanama 116,6±107 ml, postoperatif drenaj miktarı ortalama 417,3±339,9 ml ve dren kalış süresi 2,6±0,89 gün idi. Mortalite izlenmezken, komplikasyon oranı %13,7 olarak saptandı. Hastaların postoperatif ağrı skorları değerlendirildiğinde, ilk 24 saat görsel analog ağrı skoru (VAS) ortalaması 3,4, 24–48 saat 2,71 ve 48–72 saat arası 1,9 değerleri bulundu. Ortalama hastanede kalış süresi 4,3±2,5 gün ve ortalama takip süresi 34,7 ay olarak hesaplandı (1,5–124 ay arası). Nüks, Tip B2 timoma olan bir olguda gelişirken, bir hastada postoperatif 10. günde myastenik kriz gözlendi. Takip süresince hiçbir hastada tümör metastazı izlenmezken, hastalıksız sağkalım ortalaması 34,9 ay olarak saptandı. Sonuç: Myasteninin eşlik ettiği veya eşlik etmediği timoma olgularında genişletilmiş timektomi videotorakoskopik girişim veya transsternal girişim kullanılarak düşük morbidite ve mortalite ile güvenle uygulanabilir.

Anahtar Kelimeler:

timoma; timektomi; video yardımlı torakoskopik cerrahi; sternotomi; sağkalım

Outcomes of Extended Thymectomy in Myasthenic and Non-Myasthenic Thymus Tumors

Aim: We retrospectively reviewed the results of patients who underwent extended thymectomy for thymic malignancy and planned to demonstrate the therapeutic effect of surgical treatment in patients with thymus tumors. Material and Method: The results of 29 patients with thymic malignancy who underwent consecutively expanded thymectomy between October 2012 and January 2018 in our clinic were examined in detail. Preoperative, postoperative and postoperative follow-up parameters of the cases were recorded. Results: 13 of the patients were male and 16 were female. The mean age was calculated as 41.4±17.7 (range 9–75 years). Nine of the cases (31%) were accompanied by myasthenia graves (MG) disease. Mean FEV1 was 2678.17±954.5 ml and mean FEV1 was calculated as 94±19.8 ml. Thymectomy was performed with sternotomy in 20 patients and thoracoscopic thymectomy was performed in 9 patients. The mean duration of operation was 137.9±31.8 minutes (133.1±45.5 minutes in thoracoscopy group, 134.1±26.5 minutes in sternotomy group), mean perioperative bleeding was 116.6±107 ml, postoperative drainage amount was 417.3±339.9 ml and duration of drainage was 2.6±0.89 days. Complication rate was found to be 13.7% while mortality was not observed. When the postoperative pain scores of the patients were evaluated, the first 24 hour visual analogue pain score (VAS) averaged 3.4, 24–48 hours 2.71 and 48–72 hours 1.9. Mean hospital stay was 4.3±2.5 days and mean follow-up was 34.7 months (1.5–124 months). Recurrence was developed only in one patient with type B2 thymoma and a myasthenic crisis was observed in one patient, on the 10th postoperative day. While no tumor metastasis was observed in any patient during the follow-up, the mean disease-free survival was 34.9 months. Conclusion: Extended thymectomy can be safely performed with low morbidity and mortality using transsternal or thoracoscopic approach in myasthenic and non-myasthenic thymus tumors.

Keywords:

thymoma; thymectomy; video assisted thoracoscopic surgery; sternotomy; survival,

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