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Result Summary for Survey: Management of Empyema

Monday, October 25, 2010

By

Management of Thymoma

 

For purposes of this survey, participants were asked to assume that they were consulting on a middle aged patient who had findings on CT compatible with a small (2 cm) encapsulated thymoma. The patient had no symptoms related to the abnormality.  The patient was otherwise healthy and had no symptoms of myasthenia gravis.

Over 90% of respondents manage patients with thymomas, indicating that the subsequent responses reflect the opinions of active practitioners.  Almost half of the respondents routinely refer such patients for a neurologic evaluation, even in the absence of myasthenic symptoms.

Additional diagnostic/evaluation procedures are used quite commonly: MRI in 25%, needle biopsy in 25%, serum tumor markers in almost 2/3 of respondents, and open biopsy in 10%.

The most common surgical approach for such patients is a standard thymectomy.  An extended thymectomy was identified as the preferred approach in 15% of respondents.

There was no clear opinion as to whether a minimally invasive approach was appropriate for this patient.  About half of the respondents indicated a preference for an open approach.  Of the respondents who believed a minimally invasive approach was appropriate, there was no consensus as to the optimal VATS technique.

1. Do you manage patients with thymoma?
  answered question 359
 
skipped question
0
  Response
Percent
Response
Count
Yes
96.1% 345
No
3.9% 14
2. Do you typically refer patients of this type for a neurologic evaluation in the absence of symptoms suggestive of myasthenia gravis?
  answered question 356
 
skipped question
3
  Response
Percent
Response
Count
Yes
43.0% 153
No
57.0% 203
3. Do you normally perform any additional diagnostic procedure(s)? Please check which procedures you would normally perform.
  answered question 282
 
skipped question
77
  Response
Percent
Response
Count
MRI
26.2% 74
Needle biopsy
25.5% 72
Serum tumor markers
62.8% 177
Parasternal mediastinotomy or thoracoscopy for diagnosis
12.1% 34
4. What is your preferred approach to managing this problem?
  answered question 358
 
skipped question
1
  Response
Percent
Response
Count
Standard thymectomy (complete thymectomy including pericardial fat extending to the phrenic nerves bilaterally, including both upper poles of the thymus)
76.3% 273
Extended thymectomy (standard thymectomy plus additional dissection in the mediastinum and neck aimed at removing all extracapsular nests of thymic tissue)
16.5% 59
Other
7.3% 26
5. Do you believe that a minimally invasive approach is adequate for surgical management of this problem?
  answered question 354
 
skipped question
5
  Response
Percent
Response
Count
Yes
54.8% 194
No
45.2% 160
6. If you would use a minimally invasive approach for management of this problem, which approach do you normally prefer?
  answered question 329
 
skipped question
30
  Response
Percent
Response
Count
Right VATS
31.6% 104
Left VATS
11.9% 39
Bilateral VATS
18.5% 61
Transcervical
12.8% 42
Other / not applicable
25.2% 83
7. In what region is your surgical practice based?
  answered question 358
 
skipped question
1
  Response
Percent
Response
Count
North America
39.4% 141
Europe
24.6% 88
South America
6.7% 24
Asia
24.0% 86
Africa
5.3% 19

 

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