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Abstract
Objective: We performed propensity score (PS) models to compare the outcome of patients with myasthenia gravis (MG) submitted to 2 different surgical approaches: extended transsternal (T-3b) or thoracoscopic extended thymectomy (VATET).
Methods: Patients' clinical data were retrieved from the MG database of the C. Besta Neurologic Institute Foundation. In the PS analysis, a matching ratio of 1:1 of the main clinical variables was obtained for the 2 groups of patients and treatment effect was estimated by comparing their outcome.
Results: A total of 210 patients met the inclusion criteria, by having a complete set of clinical data, and were included in the PS model; a matched dataset of 122 participants (61 per group) showed an adequate balance of all the covariates. Our analysis demonstrated that 68.9% of patients who had thymectomy by the VATET technique reached the pharmacologic remission/remission status at 2 years from thymectomy compared to 34.4% of those operated on by the T-3b technique (p < 0.001), had a lower INCB-MG score (p < 0.001), and had less muscle fatigability (p = 0.004). Similar results were found considering only nonthymomatous patients with MG. Results were also confirmed by paired statistical tests.
Conclusions: Our PS matching analysis showed that VATET is a reliable and effective surgical approach alternative to T-3b in patients with MG who are candidates for thymectomy.
Classification of evidence: This study provides Class IV evidence that for patients with MG, VATET is more effective than T-3b thymectomy.
GLOSSARY
- INCB=
- C. Besta Neurologic Institute Foundation;
- MG=
- myasthenia gravis;
- PR=
- pharmacologic remission;
- PS=
- propensity score;
- RCT=
- randomized controlled trial;
- T-3b=
- extended transsternal thymectomy;
- VATET=
- video-assisted thoracoscopic extended thymectomy
Footnotes
Go to Neurology.org for full disclosures. Funding information and disclosures deemed relevant by the authors, if any, are provided at the end of the article.
Coinvestigators are listed at Neurology.org.
Supplemental data at Neurology.org
- Received October 5, 2016.
- Accepted in final form March 15, 2017.
- © 2017 American Academy of Neurology
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- Propensity score matching for thymectomy in myasthenia gravis
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