AB011. Robotic thymectomy is an ideal surgical treatment for Good’s syndrome: a case series

摘要

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.