Timectomia ampliada versus timectomia simples para tratamento de Miastenia Gravis: revisão sistemática e metanálise
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Data
2022-09-27
Autores
Reis, Tarcísio Albertin dos
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Universidade Estadual Paulista (Unesp)
Resumo
Objetivo: Demonstrar através de revisão sistemática se a timectomia ampliada confere melhores resultados no pós-operatório (PO) do que a timectomia simples no tratamento da Miastenia gravis (MG). Métodos: Foram pesquisadas as bases Medline, Embase, Lilacs, Scopus, Web of Science e Central para busca de estudos observacionais que avaliaram os resultados PO da timectomia ampliada (TA) ou da timectomia simples (TS) no tratamento da MG. Os desfechos avaliados foram: Remissão completa (RC), qualquer tipo de melhora, sem mudança (SM), piora, óbito, crise miastênica, reoperação e sangramento. Foi feita análise de subgrupos para o desfecho RC de acordo com a presença ou não de timoma e de acordo com acesso cirúrgico. Cada desfecho foi analisado por metanálise proporcional, realizada pelo programa StatsDirect 3.1.20. Nas comparações das prevalências entre duas proporções, foram analisados os intervalos de confiança: se não ocorresse a sobreposição dos intervalos de confiança haveria diferença entre elas, se ocorresse, a comparação seria através de um ajuste de regressão logística com correção de Williams para os casos que ocorressem superdispersão de dados. Resultados: O número total de pacientes avaliados em 121 estudos selecionados foi de 10818. Houve 95 estudos que avaliaram a TA com 8974 pacientes e 26 estudos avaliaram a TS com 1844 pacientes. Não houve diferença entre os desfechos avaliados: RC (p: 0,8968), qualquer tipo de melhora (p: 0,3671), SM (p: 0,575), piora (p: 0,5973), óbito (p: 0,0573), crise miastênica (p: 0,4243), reoperação (p: 0,5805) e sangramento (p: 0,9686). Na análise de subgrupos, não houve diferença na RC entre os portadores de timoma (p: 0,2252) e não portadores de timoma (p: 0,7138). Dentre os que fizeram TS, não houve diferença na RC dos submetidos a esternotomia ou cervicotomia (p: 0,8883). Dentre os que fizeram TA, não houve diferença entre os que fizeram esternotomia ou videotoracoscopia (p: 0,2178). Conclusão: não foi demonstrado superioridade da TA sobre a TS. Não foi possível demonstrar superioridade de qualquer acesso cirúrgico em relação a RC. Não foi demonstrado diferença na RC entre os pacientes portadores ou não de timoma.
Objective: Demonstrate through a systematic review whether extended thymectomy provides better postoperative (PO) results than simple thymectomy in the treatment of Myasthenia gravis (MG). Methods: Medline, Embase, Lilacs, Scopus, Web of Science and Central were searched for observational studies that evaluated the PO results of extended thymectomy (ET) or simple thymectomy (ST) in the treatment of MG. The outcomes evaluated were: complete remission (CR), any type of improvement, no change (NC), worsening, death, myasthenic crisis, reoperation and bleeding. Subgroup analysis was performed for CR outcome according to the presence or absence of thymoma and according to surgical access. Each outcome was analyzed by proportional metaanalysis, performed using the StatsDirect 3.1.20 program. When comparing the prevalence between two proportions, the confidence intervals were analyzed: if the confidence intervals did not overlap, there would be a difference between them, if there were, the comparison would be through a logistic regression adjustment with Williams correction for cases that data overdispersion occurred. Results: The total number of patients evaluated in 121 selected studies was 10818. There were 95 studies that evaluated ET with 8974 patients and 26 studies evaluated ST with 1844 patients. There was no difference between the evaluated outcomes: CR (p: 0.8968), any type of improvement (p: 0.3671), NC (p: 0.575), worsening (p: 0.5973), death (p: 0 .0573), myasthenic crisis (p: 0.4243), reoperation (p: 0.5805) and bleeding (p: 0.9686). In the subgroup analysis, there was no difference in CR between thymomatous (p: 0.2252) and non-thymomatous patients (p: 0.7138). Among those who underwent ST, there was no difference in the CR of those who underwent sternotomy or cervicotomy (p: 0.8883). Among those who underwent ET, there was no difference between those who underwent sternotomy or videothoracoscopy (p: 0.2178). Conclusion: Superiority of ET over ST was not demonstrated. It was not possible to demonstrate superiority of any surgical approach in relation to CR. There was no difference in CR between patients with or without thymoma.
Objective: Demonstrate through a systematic review whether extended thymectomy provides better postoperative (PO) results than simple thymectomy in the treatment of Myasthenia gravis (MG). Methods: Medline, Embase, Lilacs, Scopus, Web of Science and Central were searched for observational studies that evaluated the PO results of extended thymectomy (ET) or simple thymectomy (ST) in the treatment of MG. The outcomes evaluated were: complete remission (CR), any type of improvement, no change (NC), worsening, death, myasthenic crisis, reoperation and bleeding. Subgroup analysis was performed for CR outcome according to the presence or absence of thymoma and according to surgical access. Each outcome was analyzed by proportional metaanalysis, performed using the StatsDirect 3.1.20 program. When comparing the prevalence between two proportions, the confidence intervals were analyzed: if the confidence intervals did not overlap, there would be a difference between them, if there were, the comparison would be through a logistic regression adjustment with Williams correction for cases that data overdispersion occurred. Results: The total number of patients evaluated in 121 selected studies was 10818. There were 95 studies that evaluated ET with 8974 patients and 26 studies evaluated ST with 1844 patients. There was no difference between the evaluated outcomes: CR (p: 0.8968), any type of improvement (p: 0.3671), NC (p: 0.575), worsening (p: 0.5973), death (p: 0 .0573), myasthenic crisis (p: 0.4243), reoperation (p: 0.5805) and bleeding (p: 0.9686). In the subgroup analysis, there was no difference in CR between thymomatous (p: 0.2252) and non-thymomatous patients (p: 0.7138). Among those who underwent ST, there was no difference in the CR of those who underwent sternotomy or cervicotomy (p: 0.8883). Among those who underwent ET, there was no difference between those who underwent sternotomy or videothoracoscopy (p: 0.2178). Conclusion: Superiority of ET over ST was not demonstrated. It was not possible to demonstrate superiority of any surgical approach in relation to CR. There was no difference in CR between patients with or without thymoma.
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Palavras-chave
Miastenia gravis, Timectomia, Revisão sistemática, Metanálise, Systematic review, Meta-analysis, Myasthenia gravis, Thymectomy