Abstract
AB011. Robotic thymectomy is an ideal surgical treatment for Good’s syndrome: a case series
Shinya Otsuka1, Yuka Takakuwa1, Akihiro Sasaki1, Hiroshi Yamasaki1, Haruhiko Shiiya1, Kazuto Ohtaka1, Aki Fujiwara-Kuroda1, Hideki Ujiie1, Masato Aragaki1, Kanako C. Hatanaka2, Yoshihiro Matsuno2, Tatsuya Kato1
1Department of Thoracic Surgery, Hokkaido University Hospital, Sapporo, Hokkaido, Japan;
2Department of Surgical Pathology, Hokkaido University Hospital, Sapporo, Hokkaido, Japan
Correspondence to: Tatsuya Kato, MD, PhD. Department of Thoracic Surgery, Hokkaido University Hospital, Kita 14, Nishi 5, Kita-ku, Sapporo, Hokkaido 060-8648, Japan. Email: katotatu@huhp.hokudai.ac.jp.
Background: Good’s syndrome is a rare immunodeficiency disorder associated with thymomas and hypogammaglobulinemia. Although thymectomy is needed to prevent local invasion and metastasis, the prognosis of patients can be poor owing to repeated severe infection-related complications. Recently, robotic-assisted thoracoscopic surgery (RATS) is increasingly performed for resection of thymomas. At department of Thoracic Surgery in Hokkaido University Hospital, we have treated seven surgical cases of Good’s syndrome from 2007 to 2023 including three RATS cases. Here, we discuss the ideal surgical treatment for Good’s syndrome.
Case Description: All seven patients had preoperative infectious complications such as candidiasis, and received intravenous immunoglobulin. Median sternotomy was performed for two patients, video-assisted thoracoscopic surgery (VATS) was conducted for other two cases, and remaining three cases received RATS. Intraoperative blood loss was less than 10 mL in RATS cases, smaller than that in the other surgical cases. Early postoperative infectious complications were not observed in the three patients who underwent RATS. In all cases, surgical complete resection was achieved and recurrence of thymoma has not been noted. However, no cases showed improvement of hypogammaglobulinemia, and interestingly three including one RATS case developed pure red cell aplasia following thymectomy. Of the two patients who underwent VATS, one died of severe cytomegalovirus infection 8 years after thymectomy and the other died of lung adenocarcinoma 5 years postoperatively. Several reports revealed that RATS for thymectomy has some advantages including reduced blood loss and fewer perioperative infectious complications compared with median sternotomy. RATS enables earlier ambulation, and thus decreases the risk of pneumonia as well as sternal osteomyelitis. Moreover, some studies have reported that the R0 resection rate of robotic thymectomy is equivalent to that of median sternotomy even for large thymomas. The present study suggested these advantages of RATS, although the number of cases is small.
Conclusions: RATS can be a feasible surgical treatment for Good’s syndrome that ensures reduced blood loss, lower risk of postoperative infection, and complete resection of thymoma. However, hypogammaglobulinemia and accompanying autoimmune manifestations might not be improved even after surgery, and careful perioperative management is essential.
Keywords: Good’s syndrome; robotic thymectomy; hypogammaglobulinemia; case series
Acknowledgments
Funding: None.
Conflicts of Interest: All authors have completed the ICMJE uniform disclosure form (available at https://med.amegroups.com/article/view/10.21037/med-24-ab011/coif). The authors have no conflicts of interest to declare.
Ethical Statement: The authors are accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. All procedures performed in this study were in accordance with the ethical standards of the institutional and/or national research committee(s) and with the Helsinki Declaration (as revised in 2013). Written informed consent was obtained from the patients for the publication of this case series. A copy of the written consent is available for review by the editorial office of this journal.
Open Access Statement: This is an Open Access article distributed in accordance with the Creative Commons Attribution-NonCommercial-NoDerivs 4.0 International License (CC BY-NC-ND 4.0), which permits the non-commercial replication and distribution of the article with the strict proviso that no changes or edits are made and the original work is properly cited (including links to both the formal publication through the relevant DOI and the license). See: https://creativecommons.org/licenses/by-nc-nd/4.0/.
doi: 10.21037/med-24-ab011
Cite this abstract as: Otsuka S, Takakuwa Y, Sasaki A, Yamasaki H, Shiiya H, Ohtaka K, Fujiwara-Kuroda A, Ujiie H, Aragaki M, Hatanaka KC, Matsuno Y, Kato T. AB011. Robotic thymectomy is an ideal surgical treatment for Good’s syndrome: a case series. Mediastinum 2024;8:AB011.
