{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,20]],"date-time":"2026-06-20T16:57:22Z","timestamp":1781974642686,"version":"3.54.5"},"reference-count":28,"publisher":"Oxford University Press (OUP)","issue":"4","license":[{"start":{"date-parts":[[2020,12,5]],"date-time":"2020-12-05T00:00:00Z","timestamp":1607126400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/journals\/pages\/open_access\/funder_policies\/chorus\/standard_publication_model"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2021,4,29]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>\u2002<\/jats:title><\/jats:sec><jats:sec><jats:title>OBJECTIVES<\/jats:title><jats:p>The goal of this study was to compare the early and intermediate surgical outcomes, including the survival of those with and without myasthenic thymoma, following robotic thymectomy.<\/jats:p><\/jats:sec><jats:sec><jats:title>METHODS<\/jats:title><jats:p>This is a retrospective analysis of prospectively maintained data of 111 patients who underwent robotic thymectomy for thymoma over 7\u2009years in a thoracic surgery centre in India. We performed a comparative analysis of demographics, intraoperative variables and postoperative outcomes including survival of those with and without myasthenic thymoma.<\/jats:p><\/jats:sec><jats:sec><jats:title>RESULTS<\/jats:title><jats:p>Of 111 patients, 68 patients were myasthenic and 43 were non-myasthenic. The need to resect surrounding structures and conversions was greater in the myasthenic group (P\u2009=\u20090.02, P\u2009=\u20090.04). Postoperative complications were significantly higher in the myasthenic group (P\u2009=\u20090.02). No differences were observed in intensive care unit stay, the need for postoperative ventilation and the hospital stay. On correlation, a higher Masaoka stage [odds ratio 1.96, 95% confidence interval (CI) 1.22\u20133.15] and an aggressive World Health Organization histological diagnosis (odds ratio 1.58, 95% CI 1.10\u20132.26) were more likely in patients with myasthenia gravis. A total of 7 deaths (6.3%) occurred during the median follow-up of 4.2\u2009years, 5 among those with myasthenic thymoma and 2 among patients with non-myasthenic thymoma. Due to the small number of deaths, there is insufficient evidence to draw any conclusion about the effect of myasthenia gravis on survival after surgery (hazard ratio 0.51, 95% CI 0.09\u20132.71; P\u2009=\u20090.43).<\/jats:p><\/jats:sec><jats:sec><jats:title>CONCLUSIONS<\/jats:title><jats:p>The presence of myasthenia with thymoma is associated with more adjacent structure resection, higher postoperative complications and more conversions. The use of robotic surgery for thymoma resection in patients with myasthenia could not overcome the early postoperative problems related to myasthenia gravis.<\/jats:p><\/jats:sec>","DOI":"10.1093\/ejcts\/ezaa406","type":"journal-article","created":{"date-parts":[[2020,10,22]],"date-time":"2020-10-22T11:08:53Z","timestamp":1603364933000},"page":"807-813","source":"Crossref","is-referenced-by-count":11,"title":["Myasthenia is a poor prognostic factor for perioperative outcomes after robotic thymectomy for thymoma"],"prefix":"10.1093","volume":"59","author":[{"given":"Arvind","family":"Kumar","sequence":"first","affiliation":[{"name":"Centre for Chest Surgery, Sir Ganga Ram Hospital, New Delhi, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Belal Bin","family":"Asaf","sequence":"additional","affiliation":[{"name":"Centre for Chest Surgery, Sir Ganga Ram Hospital, New Delhi, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mohan Venkatesh","family":"Pulle","sequence":"additional","affiliation":[{"name":"Centre for Chest Surgery, Sir Ganga Ram Hospital, New Delhi, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5269-7976","authenticated-orcid":false,"given":"Harsh Vardhan","family":"Puri","sequence":"additional","affiliation":[{"name":"Centre for Chest Surgery, Sir Ganga Ram Hospital, New Delhi, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nitin","family":"Sethi","sequence":"additional","affiliation":[{"name":"Department of Anaesthesia, Sir Ganga Ram Hospital, New Delhi, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sukhram","family":"Bishnoi","sequence":"additional","affiliation":[{"name":"Centre for Chest Surgery, Sir Ganga Ram Hospital, New Delhi, India"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2020,12,5]]},"reference":[{"key":"2021042915250770400_ezaa406-B1","doi-asserted-by":"crossref","first-page":"378","DOI":"10.1016\/0003-4975(91)90848-K","article-title":"Primary cysts and tumors of the mediastinum","volume":"51","author":"Cohen","year":"1991","journal-title":"Ann Thorac Surg"},{"key":"2021042915250770400_ezaa406-B2","doi-asserted-by":"crossref","first-page":"376","DOI":"10.1016\/S0022-5223(96)70265-9","article-title":"Prognostic factors and long-term results after thymoma resection: a series of 307 patients","volume":"112","author":"Regnard","year":"1996","journal-title":"J Thorac Cardiovasc Surg"},{"key":"2021042915250770400_ezaa406-B3","doi-asserted-by":"crossref","first-page":"359","DOI":"10.1111\/j.1440-1827.1994.tb02936.x","article-title":"A review of 79 thymomas: modification of staging system and reappraisal of conventional division into invasive and non-invasive thymoma","volume":"44","author":"Koga","year":"2008","journal-title":"Pathol Int"},{"key":"2021042915250770400_ezaa406-B4","doi-asserted-by":"crossref","first-page":"1383","DOI":"10.1097\/JTO.0000000000000654","article-title":"The 2015 WHO classification of tumors of the thymus: continuity and changes","volume":"10","author":"Marx","year":"2015","journal-title":"J Thorac Oncol"},{"key":"2021042915250770400_ezaa406-B5","doi-asserted-by":"crossref","first-page":"327","DOI":"10.1016\/S0003-4975(00)01595-2","article-title":"Myasthenia gravis: recommendations for clinical research standards. Task Force of the Medical Scientific Advisory Board of the Myasthenia Gravis Foundation of America Myasthenia Gravis: recommendations for clinical research standards","volume":"70","author":"Jaretzki","year":"2000","journal-title":"Ann Thorac Surg"},{"key":"2021042915250770400_ezaa406-B6","doi-asserted-by":"crossref","first-page":"201","DOI":"10.1002\/bjs.18003313102","article-title":"The surgery of the thymus gland","volume":"33","author":"Keynes","year":"1946","journal-title":"Br J Surg"},{"key":"2021042915250770400_ezaa406-B7","doi-asserted-by":"crossref","first-page":"e68","DOI":"10.1093\/ejcts\/ezt557","article-title":"Early clinical outcomes of robot-assisted surgery for anterior mediastinal mass: its superiority over a conventional sternotomy approach evaluated by propensity score matching","volume":"45","author":"Seong","year":"2014","journal-title":"Eur J Cardiothorac Surg"},{"key":"2021042915250770400_ezaa406-B8","doi-asserted-by":"crossref","first-page":"58","DOI":"10.4103\/0028-3886.198211","article-title":"Robotic thymectomy for myasthenia gravis with or without thymoma\u2013surgical and neurological outcomes","volume":"65","author":"Kumar","year":"2017","journal-title":"Neurol India"},{"key":"2021042915250770400_ezaa406-B9","doi-asserted-by":"crossref","first-page":"S315","DOI":"10.1016\/S0959-8049(11)70184-8","article-title":"Thymoma update 2011","volume":"47","author":"Baas","year":"2011","journal-title":"Eur J Cancer"},{"key":"2021042915250770400_ezaa406-B10","doi-asserted-by":"crossref","first-page":"569","DOI":"10.1007\/s12149-009-0283-z","article-title":"Characterization of thymic masses using 18F-FDG PET-CT","volume":"23","author":"Kumar","year":"2009","journal-title":"Ann Nucl Med"},{"key":"2021042915250770400_ezaa406-B11","doi-asserted-by":"crossref","first-page":"203","DOI":"10.1016\/S0003-4975(01)02633-9","article-title":"Thymoma: trends over time","volume":"72","author":"Moore","year":"2001","journal-title":"Ann Thorac Surg"},{"key":"2021042915250770400_ezaa406-B12","first-page":"18","article-title":"Multi-institutional European experience of robotic thymectomy for thymoma","volume":"5","author":"Marulli","year":"2016","journal-title":"Ann Cardiothorac Surg"},{"key":"2021042915250770400_ezaa406-B13","doi-asserted-by":"crossref","first-page":"1272","DOI":"10.1007\/s00464-007-9606-0","article-title":"Alternative choices of total and partial thymectomy in video-assisted resection of noninvasive thymomas","volume":"22","author":"Sakamaki","year":"2008","journal-title":"Surg Endosc"},{"key":"2021042915250770400_ezaa406-B14","doi-asserted-by":"crossref","first-page":"60","DOI":"10.4103\/0972-9941.147693","article-title":"Robotic thoracic surgery: the state of the art","volume":"11","author":"Kumar","year":"2015","journal-title":"J Minim Access Surg"},{"key":"2021042915250770400_ezaa406-B15","doi-asserted-by":"crossref","first-page":"501","DOI":"10.1016\/j.ejcts.2006.12.016","article-title":"A comparison of outcomes after robotic open extended thymectomy for myasthenia gravis","volume":"31","author":"Cakar","year":"2007","journal-title":"Eur J Cardiothorac Surg"},{"key":"2021042915250770400_ezaa406-B16","doi-asserted-by":"crossref","first-page":"30","DOI":"10.1016\/j.neurol.2012.02.013","article-title":"Robotic-assisted thymectomy with Da Vinci II versus sternotomy in the surgical treatment of non-thymomatous myasthenia gravis: early results","volume":"169","author":"Renaud","year":"2013","journal-title":"Rev Neurol (Paris)"},{"key":"2021042915250770400_ezaa406-B17","doi-asserted-by":"crossref","first-page":"579","DOI":"10.1093\/ejcts\/ezy075","article-title":"Comparing robotic and trans-sternal thymectomy for early-stage thymoma: a propensity score-matching study","volume":"54","author":"Marulli","year":"2018","journal-title":"Eur J Cardiothorac Surg"},{"key":"2021042915250770400_ezaa406-B18","doi-asserted-by":"crossref","first-page":"174","DOI":"10.21037\/acs.2019.02.04","article-title":"A systematic review of robotic versus open and video assisted thoracoscopic surgery (VATS) approaches for thymectomy","volume":"8","author":"O\u2019Sullivan","year":"2019","journal-title":"Ann Cardiothorac Surg"},{"key":"2021042915250770400_ezaa406-B19","doi-asserted-by":"crossref","first-page":"137","DOI":"10.1046\/j.1468-1331.1998.520137.x","article-title":"The management and outcome of patients with myasthenia gravis treated acutely in a neurological intensive care unit","volume":"5","author":"O'Riordan","year":"1998","journal-title":"Eur J Neurol"},{"key":"2021042915250770400_ezaa406-B20","doi-asserted-by":"crossref","first-page":"868","DOI":"10.1016\/j.jtcvs.2003.07.036","article-title":"Prognostic factors for myasthenic crisis after transsternal thymectomy in patients with myasthenia gravis","volume":"127","author":"Watanabe","year":"2004","journal-title":"J Thorac Cardiovasc Surg"},{"key":"2021042915250770400_ezaa406-B21","doi-asserted-by":"crossref","first-page":"201","DOI":"10.1007\/s11748-015-0518-y","article-title":"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","volume":"63","author":"Kadota","year":"2015","journal-title":"Gen Thorac Cardiovasc Surg"},{"key":"2021042915250770400_ezaa406-B22","doi-asserted-by":"crossref","first-page":"1555","DOI":"10.1007\/s00464-012-2626-4","article-title":"It is feasible to operate on pathological Masaoka stage I and II thymoma patients with video-assisted thoracoscopy: analysis of factors for a successful resection","volume":"27","author":"Toker","year":"2013","journal-title":"Surg Endosc"},{"key":"2021042915250770400_ezaa406-B23","doi-asserted-by":"crossref","first-page":"1007","DOI":"10.1510\/icvts.2007.170894","article-title":"Surgical outcome in thymic tumors with myasthenia gravis after plasmapheresisa comparative study","volume":"7","author":"Sarkar","year":"2008","journal-title":"Interact CardioVasc Thorac Surg"},{"key":"2021042915250770400_ezaa406-B24","doi-asserted-by":"crossref","first-page":"352","DOI":"10.1097\/CND.0b013e3181660807","article-title":"A comparison of the effectiveness of intravenous immunoglobulin and plasma exchange as preoperative therapy of myasthenia gravis","volume":"9","author":"Jensen","year":"2008","journal-title":"J Clin Neuromusc Dis"},{"key":"2021042915250770400_ezaa406-B25","doi-asserted-by":"crossref","first-page":"509","DOI":"10.1016\/j.hoc.2008.03.004","article-title":"Thymoma, myasthenia gravis, and other paraneoplastic syndromes","volume":"22","author":"Tormoehlen","year":"2008","journal-title":"Hematol Oncol Clin North Am"},{"key":"2021042915250770400_ezaa406-B26","doi-asserted-by":"crossref","first-page":"43","DOI":"10.1016\/S0022-5223(19)37441-0","article-title":"Results of surgical treatment for thymoma","volume":"87","author":"Shamji","year":"1984","journal-title":"J Thorac Cardiovasc Surg"},{"key":"2021042915250770400_ezaa406-B27","doi-asserted-by":"crossref","first-page":"245","DOI":"10.1016\/j.athoracsur.2009.08.074","article-title":"Thirty-five year follow-up analysis of clinical and pathologic outcomes of thymoma surgery","volume":"89","author":"Margaritora","year":"2010","journal-title":"Ann Thorac Surg"},{"key":"2021042915250770400_ezaa406-B28","doi-asserted-by":"crossref","first-page":"146","DOI":"10.1016\/j.ejcts.2010.09.042","article-title":"Thymoma: inter-relationships among World Health Organization histology, Masaoka staging and myasthenia gravis and their independent prognostic significance: a single-centre experience","volume":"40","author":"Ruffini","year":"2011","journal-title":"Eur J Cardiothorac Surg"}],"container-title":["European Journal of Cardio-Thoracic Surgery"],"original-title":[],"language":"en","link":[{"URL":"http:\/\/academic.oup.com\/ejcts\/article-pdf\/59\/4\/807\/37582723\/ezaa406.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"http:\/\/academic.oup.com\/ejcts\/article-pdf\/59\/4\/807\/37582723\/ezaa406.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,8,16]],"date-time":"2024-08-16T07:55:46Z","timestamp":1723794946000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/ejcts\/article\/59\/4\/807\/6024824"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2020,12,5]]},"references-count":28,"journal-issue":{"issue":"4","published-online":{"date-parts":[[2020,12,5]]},"published-print":{"date-parts":[[2021,4,29]]}},"URL":"https:\/\/doi.org\/10.1093\/ejcts\/ezaa406","relation":{},"ISSN":["1010-7940","1873-734X"],"issn-type":[{"value":"1010-7940","type":"print"},{"value":"1873-734X","type":"electronic"}],"subject":[],"published-other":{"date-parts":[[2021,4,1]]},"published":{"date-parts":[[2020,12,5]]}}}