Surgical Safety Analysis and Clinical Experience Sharing of Myasthenia Gravis Patients Aged 65 and over

Overview

Journal Thorac Cancer

Specialties Oncology
Pulmonary Medicine

Date 2023 Jan 24

PMID 36691325

Authors

Peng Jiao

Fanjuan Wu

Jiangyu Wu

Yaoguang Sun

Wenxin Tian

Hanbo Yu

Chuan Huang

Donghang Li

Qingjun Wu

Chao Ma

Hongfeng Tong

Affiliations

Soon will be listed here.

Abstract

Background: To evaluate the surgical safety in myasthenia gravis (MG) patients aged 65 and over.

Methods: A total of 564 patients with MG who underwent surgery in the Department of Thoracic Surgery of Beijing Hospital from November 2011 to March 2022 were included in the study and divided into two groups taking the age of 65 as the boundary. Perioperative data of patients were recorded and statistically analyzed.

Results: Compared with young patients, FEV1, FEV1% and MVV in lung function of elderly MG patients were worse (p < 0.001, p < 0.001, p = 0.002). Postoperative drainage time was longer (p < 0.001), combined with more drainage volume (p = 0.002). The American Society of Anesthesiologists (ASA) score of elderly MG patients was higher (p < 0.001). Complications were more likely to occur (p = 0.008) after surgery and Clavien-Dindo classification (CDC) of postoperative complications was also higher (p = 0.003). Meanwhile, postoperative myasthenic crisis (POMC) was more likely to occur (p = 0.038). Logistic regression showed that lower DLCO% (p = 0.049) was an independent risk factor for postoperative complications.

Conclusions: Surgical indications should be considered in each elderly MG patient on an individual basis. Moreover, most elderly MG patients safely survive the perioperative period and benefit from surgery through individualized consideration.

Citing Articles

Thymoma resection and myasthenia gravis: what is the neurological outcome in patients older than 65 years?.

Lococo F, Sassorossi C, Maurizi G, Santoro G, Iorio R, Falso S Updates Surg. 2024; .

PMID: 38980595 DOI: 10.1007/s13304-024-01937-w.

Surgical safety analysis and clinical experience sharing of myasthenia gravis patients aged 65 and over.

Jiao P, Wu F, Wu J, Sun Y, Tian W, Yu H Thorac Cancer. 2023; 14(8):717-723.

PMID: 36691325 PMC: 10008675. DOI: 10.1111/1759-7714.14799.

References

Zielinski M, Hauer L, Hauer J, Pankowski J, Nabialek T, Szlubowski A . Comparison of complete remission rates after 5 year follow-up of three different techniques of thymectomy for myasthenia gravis. Eur J Cardiothorac Surg. 2010; 37(5):1137-43. DOI: 10.1016/j.ejcts.2009.11.029. View

Li H, Ruan Z, Gao F, Zhou H, Guo R, Sun C . Thymectomy and Risk of Generalization in Patients with Ocular Myasthenia Gravis: A Multicenter Retrospective Cohort Study. Neurotherapeutics. 2021; 18(4):2449-2457. PMC: 8804035. DOI: 10.1007/s13311-021-01129-z. View

Tamura S, Sugawara Y, Kaneko J, Yamashiki N, Kishi Y, Matsui Y . Systematic grading of surgical complications in live liver donors according to Clavien's system. Transpl Int. 2006; 19(12):982-7. DOI: 10.1111/j.1432-2277.2006.00375.x. View

Matsuzaki Y, Tomita M, Onitsuka T, Shibata K . Influence of age on extended thymectomy as a treatment for myasthenia gravis. Ann Thorac Cardiovasc Surg. 1998; 4(4):192-5. View

Grob D, Brunner N, Namba T, Pagala M . Lifetime course of myasthenia gravis. Muscle Nerve. 2007; 37(2):141-9. DOI: 10.1002/mus.20950. View

Seely A, Ivanovic J, Threader J, Al-Hussaini A, Al-Shehab D, Ramsay T . Systematic classification of morbidity and mortality after thoracic surgery. Ann Thorac Surg. 2010; 90(3):936-42. DOI: 10.1016/j.athoracsur.2010.05.014. View

Kadota Y, Horio H, Mori T, Sawabata N, Goto T, Yamashita S . Perioperative management in myasthenia gravis: republication of a systematic review and a proposal by the guideline committee of the Japanese Association for Chest Surgery 2014. Gen Thorac Cardiovasc Surg. 2015; 63(4):201-15. DOI: 10.1007/s11748-015-0518-y. View

Kikuchi R, Watabe N, Konno T, Mishina N, Sekizawa K, Sasaki H . High incidence of silent aspiration in elderly patients with community-acquired pneumonia. Am J Respir Crit Care Med. 1994; 150(1):251-3. DOI: 10.1164/ajrccm.150.1.8025758. View

Prigent H, Orlikowski D, Letilly N, Falaize L, Annane D, Sharshar T . Vital capacity versus maximal inspiratory pressure in patients with Guillain-Barré syndrome and myasthenia gravis. Neurocrit Care. 2011; 17(2):236-9. DOI: 10.1007/s12028-011-9575-y. View

10.

Murai H, Yamashita N, Watanabe M, Nomura Y, Motomura M, Yoshikawa H . Characteristics of myasthenia gravis according to onset-age: Japanese nationwide survey. J Neurol Sci. 2011; 305(1-2):97-102. DOI: 10.1016/j.jns.2011.03.004. View

11.

Matsui N, Nakane S, Nakagawa Y, Kondo K, Mitsui T, Matsumoto T . Increasing incidence of elderly onset patients with myasthenia gravis in a local area of Japan. J Neurol Neurosurg Psychiatry. 2009; 80(10):1168-71. DOI: 10.1136/jnnp.2008.152637. View

12.

Aarli J . Myasthenia gravis in the elderly: Is it different?. Ann N Y Acad Sci. 2008; 1132:238-43. DOI: 10.1196/annals.1405.040. View

13.

Sankar A, Johnson S, Beattie W, Tait G, Wijeysundera D . Reliability of the American Society of Anesthesiologists physical status scale in clinical practice. Br J Anaesth. 2014; 113(3):424-32. PMC: 4136425. DOI: 10.1093/bja/aeu100. View

14.

Huang X, Li Y, Feng H, Chen P, Liu W . Clinical Characteristics of Juvenile Myasthenia Gravis in Southern China. Front Neurol. 2018; 9:77. PMC: 5835068. DOI: 10.3389/fneur.2018.00077. View

15.

Tsuchida M, Yamato Y, Souma T, Yoshiya K, Watanabe T, Aoki T . Efficacy and safety of extended thymectomy for elderly patients with myasthenia gravis. Ann Thorac Surg. 1999; 67(6):1563-7. DOI: 10.1016/s0003-4975(99)00167-8. View

16.

Carr A, Cardwell C, McCarron P, McConville J . A systematic review of population based epidemiological studies in Myasthenia Gravis. BMC Neurol. 2010; 10:46. PMC: 2905354. DOI: 10.1186/1471-2377-10-46. View

17.

Clavien P, Sanabria J, Strasberg S . Proposed classification of complications of surgery with examples of utility in cholecystectomy. Surgery. 1992; 111(5):518-26. View

18.

Hong Y, Skeie G, Zisimopoulou P, Karagiorgou K, Tzartos S, Gao X . Juvenile-onset myasthenia gravis: autoantibody status, clinical characteristics and genetic polymorphisms. J Neurol. 2017; 264(5):955-962. DOI: 10.1007/s00415-017-8478-z. View

19.

Motomura M . [Standard treatment for late-onset myasthenia gravis in Japan]. Rinsho Shinkeigaku. 2011; 51(8):576-82. DOI: 10.5692/clinicalneurol.51.576. View

20.

DeOliveira M, Winter J, Schafer M, Cunningham S, Cameron J, Yeo C . Assessment of complications after pancreatic surgery: A novel grading system applied to 633 patients undergoing pancreaticoduodenectomy. Ann Surg. 2006; 244(6):931-7. PMC: 1856636. DOI: 10.1097/01.sla.0000246856.03918.9a. View