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Аnalysis intra and postoperative clinical outcomes after thymus tumor stage I and II surgery depending upon surgical approach

dc.contributor.advisorMilisavljević, Slobodan
dc.contributor.otherVekić, Berislav
dc.contributor.otherRadovanović, Dragče
dc.contributor.otherMilev, Boško
dc.creatorKostovski, Vanja
dc.date.accessioned2021-10-29T11:19:01Z
dc.date.available2021-10-29T11:19:01Z
dc.date.issued2021-03-30
dc.identifier.urihttp://eteze.kg.ac.rs/application/showtheses?thesesId=8144
dc.identifier.urihttps://fedorakg.kg.ac.rs/fedora/get/o:1375/bdef:Content/download
dc.identifier.urihttps://nardus.mpn.gov.rs/handle/123456789/18702
dc.description.abstractUvod: Resekcija/ operacija je prvi i najvažniji modalitet lečenja tumora timusa; mogućnost sprovođenja kompletne resekcije je najznačajniji parametar koji definiše dugoročnu prognozu. Postoje kontroverzni stavovi kada je u pitanju indikacija za operaciju, hirurški pristup, mesto torakoskopskih metoda kao i ekstenzivnost resekcije. Minimalno invazivni pristup je preporučena opcija u I–II stadijumu tumora, dok za III stadijum ne postoje podaci o dugoročnom preživljavanju operisanih, tako da se referiše otvorena hirurgija kao terapijski pristup. Metod: Studija je obuhvatila 148 pacijenata sa primarnim tumora timusa lečenih u Klinici za grudnu i kardiohirurgiju VMA u periodu između maja 2006. i februara 2018. godine. Od ukupnog broja operisanih, 116 pacijenata je imalo patohistološki verifikovan stadijum I-II timoma po Masaoka klasifikaciji. Koristeći propenziti skor baziran na 6 bazalnih zbunjujućih varijabli (pol, starost, indeks telesne mase, prisustvo mijastenije, veličina tumora, stadijum po Masaoka-Koga klasifikaciji) svaki pacijent u grupi lečenih VATS-om je „mečovan― sa pacijentom u grupi lečenih standarnom timektomijom sa istim propenziti skorom. Onkološki i perioperativni ishodi (intraoperativni i postoperativni) koji utiču na efikasnost i bezbednost hirurške tehnike su analizirani i upoređeni između dve grupe. Rezultati: Od 116 pacijenata sa Masaoka-Koga stadijumom I-II timoma, 100 pacijenata (86.2%) je mečovano. Od 50 pacijenata operisanih VATS-om, u 34 pacijenta (68%) je primenjen uniportalni pristup, u 13 pacijenata (26%) biportalni, a u 3 pacijenta (6%) triportalni pristup. VATS operacija je značajno kraće trajala (p < 0.001), kao i torakalna drenaža i hospitalizacija pacijenata operisanih VATS-om (p < 0.001, p < 0.001). Lečeni VATS-om su se kasnije javljali na kontrolu (p < 0.001). Nije bilo razlike u pogledu VAS skora za bol, kao ni u pogledu vremena nastanka recidiva između ispitivanih grupa (p = 0.305, p = 0.268). Zaključak: Naše istraživanje je rezultiralo klinički značajnim podacima o VATS torakoskopiji kao dominatnom operativnom putu u poređenju sa standardnom timektomijom, koji su potvrdili veću bezbednost i veću efikasnosti VATS-a, kao i manju učestalost postoperativnih komplikacija i brži oporavak. U odnosu na standardnu sternotomiju, VATS timektomija je podjednako efikasna i značajno bezbednija metoda sa minimalnom stopom intra i postoperativnih komplikacija.sr
dc.description.abstractIntroduction: Complete resection is the first and the most important modality of treatment of thymus tumors; the radicality of the resection defines long-term prognosis. There are some controversials considering the indication for surgery, surgical approach, surgical methods and the extensiveness of resection. Minimally invasive method is recommended in stage I–II thymoma, but for stage III there are no data considering long- term survival, so the reffered surgical approach is standard thymectomy. Method: The study included 148 patients with primary thymus tumor, treated between May 2006 and February 2018 in Clinic for cardiothoracic surgery MMA. 116 treated patients had pathohistologically verified Masaoka-Koga stage I and II thymoma. By using propensity score analysis (based on 6 variables: sex, age, body mass index, myasthenia, tumor size, Masaoka classification stage) every patient treated with VATS was matched with the patient treated with standard thymectomy with the same propensity score. Oncological (direct postoperative survival, recurrence) and perioperative outcomes (intra and postoperative complications, length of hospitalization) that affect the efficacy and safety of surgical techniques have been analyzed and compared between the two groups. Results: From the total number of 116 patients with Masaoka- Koga stage I-II thymoma, 100 patients (86.2%) were matched. Among 50 patients operated by VATS, 34 patients (68%) were treated by uniportal approach, 13 (26%) by biportal and 3 (6%) by threeportal approach. The VATS intervention had shorter intervention time, duration of chest tube placement and post-operative hospital stay (p < 0.001, p < 0.001, p < 0.001). There was a significant difference in terms of late control, VATS treated patients came later (p < 0.001). There was no significant difference between the groups regarding visual analog scale score, as well as in terms of the time of recurrence (p = 0.305, p = 0.268). Conclusion: Our study resulted in clinically relevant data considering VATS thoracoscopy as the dominant surgical approach compared to standard thymectomy, supporting previous knowledge considering safety and effectiveness of VATS technic, as well as less incidence of postoperative complications and shorter recovery. Compared to standard sternotomy, VATS thymectomy is an equally effective and significantly safer method with a minimum rate of intra and postoperative complications.en
dc.formatapplication/pdf
dc.languagesr
dc.publisherУниверзитет у Крагујевцу, Факултет медицинских наукаsr
dc.rightsopenAccessen
dc.rights.urihttps://creativecommons.org/licenses/by-nc-nd/4.0/
dc.sourceУниверзитет у Крагујевцуsr
dc.subjecttimom, video asistirana torakoskopija, otvorena timektomijasr
dc.subjectthymoma, video assisted thoracoscopy, open thymectomyen
dc.titleAnaliza neposrednih kliničkih ishoda nakon operacije malignih tumora timusa I i II stadijuma u zavisnosti od vrste operativnog pristupasr
dc.title.alternativeАnalysis intra and postoperative clinical outcomes after thymus tumor stage I and II surgery depending upon surgical approachen
dc.typedoctoralThesis
dc.rights.licenseBY-NC-ND
dc.identifier.fulltexthttps://nardus.mpn.gov.rs/bitstream/id/77375/Vanja_Kostovski_Medicinski.pdf
dc.identifier.fulltexthttps://nardus.mpn.gov.rs/bitstream/id/77374/Doctoral_thesis_11664.pdf
dc.identifier.rcubhttps://hdl.handle.net/21.15107/rcub_nardus_18702


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