Damian McNamara

MIAMI – Some researchers suggest contralateral prophylactic mastectomy increases costs, compared with a less-extensive ipsilateral procedure. But if true, the additional cost of the surgery needs to be couched within patient concerns about survival, Dr. Anees Chagpar said at the annual Miami Breast Cancer Conference, held by Physicians’ Education Resource.

The cost-effectiveness can vary based on patient age. In addition, there are costs associated with not undergoing a prophylactic mastectomy that are often not considered, added Dr. Chagpar, director of the Breast Center, Smilow Cancer Hospital at Yale-New Haven (Conn.).

Dr. Chagpar reported no relevant financial disclosures.

MIAMI – Some researchers suggest contralateral prophylactic mastectomy increases costs, compared with a less-extensive ipsilateral procedure. But if true, the additional cost of the surgery needs to be couched within patient concerns about survival, Dr. Anees Chagpar said at the annual Miami Breast Cancer Conference, held by Physicians’ Education Resource.

The cost-effectiveness can vary based on patient age. In addition, there are costs associated with not undergoing a prophylactic mastectomy that are often not considered, added Dr. Chagpar, director of the Breast Center, Smilow Cancer Hospital at Yale-New Haven (Conn.).

Dr. Chagpar reported no relevant financial disclosures.

MIAMI – Some researchers suggest contralateral prophylactic mastectomy increases costs, compared with a less-extensive ipsilateral procedure. But if true, the additional cost of the surgery needs to be couched within patient concerns about survival, Dr. Anees Chagpar said at the annual Miami Breast Cancer Conference, held by Physicians’ Education Resource.

The cost-effectiveness can vary based on patient age. In addition, there are costs associated with not undergoing a prophylactic mastectomy that are often not considered, added Dr. Chagpar, director of the Breast Center, Smilow Cancer Hospital at Yale-New Haven (Conn.).

Dr. Chagpar reported no relevant financial disclosures.

MIAMI – Physicians generally herald advances in medical imaging technology to improve and inform clinical decision-making for their patients. However, greater precision in MRI findings can leave physicians wondering how to advise patients concerned about a contralateral breast cancer, Dr. Anees Chagpar said.

It boils down to clinical significance and anxiety. Smaller lesions now detected by MRI may or may not indicate a true increase in risk, Dr. Chagpar said at the annual Miami Breast Cancer Conference, held by Physicians’ Education Resource. In addition, evidence suggests just having an MRI raises anxiety in some women with unilateral breast cancer, regardless of results. She advises providers to carefully consider why they’re ordering an MRI and the potential impact on a patient already at a heightened state of anxiety from their initial diagnosis.

Dr. Chagpar, director of the Breast Center, Smilow Cancer Hospital at Yale-New Haven (Conn.), reported no relevant financial disclosures.

MIAMI – Physicians generally herald advances in medical imaging technology to improve and inform clinical decision-making for their patients. However, greater precision in MRI findings can leave physicians wondering how to advise patients concerned about a contralateral breast cancer, Dr. Anees Chagpar said.

It boils down to clinical significance and anxiety. Smaller lesions now detected by MRI may or may not indicate a true increase in risk, Dr. Chagpar said at the annual Miami Breast Cancer Conference, held by Physicians’ Education Resource. In addition, evidence suggests just having an MRI raises anxiety in some women with unilateral breast cancer, regardless of results. She advises providers to carefully consider why they’re ordering an MRI and the potential impact on a patient already at a heightened state of anxiety from their initial diagnosis.

Dr. Chagpar, director of the Breast Center, Smilow Cancer Hospital at Yale-New Haven (Conn.), reported no relevant financial disclosures.

MIAMI – Physicians generally herald advances in medical imaging technology to improve and inform clinical decision-making for their patients. However, greater precision in MRI findings can leave physicians wondering how to advise patients concerned about a contralateral breast cancer, Dr. Anees Chagpar said.

It boils down to clinical significance and anxiety. Smaller lesions now detected by MRI may or may not indicate a true increase in risk, Dr. Chagpar said at the annual Miami Breast Cancer Conference, held by Physicians’ Education Resource. In addition, evidence suggests just having an MRI raises anxiety in some women with unilateral breast cancer, regardless of results. She advises providers to carefully consider why they’re ordering an MRI and the potential impact on a patient already at a heightened state of anxiety from their initial diagnosis.

Dr. Chagpar, director of the Breast Center, Smilow Cancer Hospital at Yale-New Haven (Conn.), reported no relevant financial disclosures.

MIAMI – The number of women with ipsilateral breast cancer seeking a contralateral mastectomy to reduce their future risk and, essentially, for peace of mind, is increasing. Dr. Anees Chagpar director of the Breast Center, Smilow Cancer Hospital at Yale-New Haven (Conn.), suggests what doctors can include in discussions with these patients.

Presenting patients with a complete picture of risks and benefits promotes shared decision-making. Consider the absolute risk reduction provided by this type of surgery, particularly in older patients who are not BRCA 1 or 2 carriers, Dr. Chagpar said at the annual Miami Breast Cancer Conference, held by Physicians’ Education Resource.

Differences between unilateral and bilateral surgery go beyond operative time, duration of hospital stay, and risk of complications, Dr. Chagpar said, and should include a discussion about patient values and what is driving their consideration of this surgery.

Dr. Chagpar had no relevant financial disclosures.

MIAMI – The number of women with ipsilateral breast cancer seeking a contralateral mastectomy to reduce their future risk and, essentially, for peace of mind, is increasing. Dr. Anees Chagpar director of the Breast Center, Smilow Cancer Hospital at Yale-New Haven (Conn.), suggests what doctors can include in discussions with these patients.

Presenting patients with a complete picture of risks and benefits promotes shared decision-making. Consider the absolute risk reduction provided by this type of surgery, particularly in older patients who are not BRCA 1 or 2 carriers, Dr. Chagpar said at the annual Miami Breast Cancer Conference, held by Physicians’ Education Resource.

Differences between unilateral and bilateral surgery go beyond operative time, duration of hospital stay, and risk of complications, Dr. Chagpar said, and should include a discussion about patient values and what is driving their consideration of this surgery.

Dr. Chagpar had no relevant financial disclosures.

MIAMI – The number of women with ipsilateral breast cancer seeking a contralateral mastectomy to reduce their future risk and, essentially, for peace of mind, is increasing. Dr. Anees Chagpar director of the Breast Center, Smilow Cancer Hospital at Yale-New Haven (Conn.), suggests what doctors can include in discussions with these patients.

Presenting patients with a complete picture of risks and benefits promotes shared decision-making. Consider the absolute risk reduction provided by this type of surgery, particularly in older patients who are not BRCA 1 or 2 carriers, Dr. Chagpar said at the annual Miami Breast Cancer Conference, held by Physicians’ Education Resource.

Differences between unilateral and bilateral surgery go beyond operative time, duration of hospital stay, and risk of complications, Dr. Chagpar said, and should include a discussion about patient values and what is driving their consideration of this surgery.

Dr. Chagpar had no relevant financial disclosures.

MIAMI – In addition to a thorough discussion of the risks and benefits of breast-conserving therapy and mastectomy, physicians need to address the individual concerns that each patient will have before choosing a procedure, Dr. Patrick Borgen, chair of the department of surgery at Maimonides Medical Center in Brooklyn, N.Y., said.

The facts do not support the superiority of one procedure over another for all women, Dr. Borgen said at the annual Miami Breast Cancer Conference, held by Physicians’ Education Resource. When discussing the options, each individual patient will have unique concerns and quality of life issues that need to be factored into a collaborative decision about the choice of procedure.

Not including mastectomy in the conversation could be a disservice to the patient, Dr. Borgen said. Quality of life over time, patient anxiety, and “the price of vigilance” are additional factors that patients consider when weighing their surgical options.

Dr. Borgen had no relevant financial disclosures.

MIAMI – In addition to a thorough discussion of the risks and benefits of breast-conserving therapy and mastectomy, physicians need to address the individual concerns that each patient will have before choosing a procedure, Dr. Patrick Borgen, chair of the department of surgery at Maimonides Medical Center in Brooklyn, N.Y., said.

The facts do not support the superiority of one procedure over another for all women, Dr. Borgen said at the annual Miami Breast Cancer Conference, held by Physicians’ Education Resource. When discussing the options, each individual patient will have unique concerns and quality of life issues that need to be factored into a collaborative decision about the choice of procedure.

Not including mastectomy in the conversation could be a disservice to the patient, Dr. Borgen said. Quality of life over time, patient anxiety, and “the price of vigilance” are additional factors that patients consider when weighing their surgical options.

Dr. Borgen had no relevant financial disclosures.

MIAMI – In addition to a thorough discussion of the risks and benefits of breast-conserving therapy and mastectomy, physicians need to address the individual concerns that each patient will have before choosing a procedure, Dr. Patrick Borgen, chair of the department of surgery at Maimonides Medical Center in Brooklyn, N.Y., said.

The facts do not support the superiority of one procedure over another for all women, Dr. Borgen said at the annual Miami Breast Cancer Conference, held by Physicians’ Education Resource. When discussing the options, each individual patient will have unique concerns and quality of life issues that need to be factored into a collaborative decision about the choice of procedure.

Not including mastectomy in the conversation could be a disservice to the patient, Dr. Borgen said. Quality of life over time, patient anxiety, and “the price of vigilance” are additional factors that patients consider when weighing their surgical options.

Dr. Borgen had no relevant financial disclosures.

MIAMI – The message from major trials evaluating tamoxifen, raloxifene, and aromatase inhibitors for chemoprevention of invasive breast cancer got clearer with data from extended follow-up coming in. Interestingly, sometimes the longer duration studies confirm earlier findings, and sometimes they do not – and researchers end up reaching new conclusions, Dr. Banu Arun of the University of Texas MD Anderson Cancer Center in Houston explained at the annual Miami Breast Cancer Conference, held by Physicians’ Education Resource.

Although not everyone agrees, Dr. Arun said why she believes there is still a role for chemoprevention of invasive breast cancer. In cases where studies do not point to a clear-cut difference in survival outcomes between agents, she recommends physicians select therapy based on other risks, benefits, and other considerations.

Technology also presents a challenge. Advances in next generation sequencing, for example, allow physicians to order a test for up to 25 genetic mutations associated with breast cancer. Compared with earlier assays that only tested for well-known risk factors like BRCA 1 and BRCA 2, these panels can return results where the clinical implications remain uncertain, leaving doctors unclear on how to counsel patients.

Dr. Arun had no relevant financial disclosures.

MIAMI – The message from major trials evaluating tamoxifen, raloxifene, and aromatase inhibitors for chemoprevention of invasive breast cancer got clearer with data from extended follow-up coming in. Interestingly, sometimes the longer duration studies confirm earlier findings, and sometimes they do not – and researchers end up reaching new conclusions, Dr. Banu Arun of the University of Texas MD Anderson Cancer Center in Houston explained at the annual Miami Breast Cancer Conference, held by Physicians’ Education Resource.

Although not everyone agrees, Dr. Arun said why she believes there is still a role for chemoprevention of invasive breast cancer. In cases where studies do not point to a clear-cut difference in survival outcomes between agents, she recommends physicians select therapy based on other risks, benefits, and other considerations.

Technology also presents a challenge. Advances in next generation sequencing, for example, allow physicians to order a test for up to 25 genetic mutations associated with breast cancer. Compared with earlier assays that only tested for well-known risk factors like BRCA 1 and BRCA 2, these panels can return results where the clinical implications remain uncertain, leaving doctors unclear on how to counsel patients.

Dr. Arun had no relevant financial disclosures.

MIAMI – The message from major trials evaluating tamoxifen, raloxifene, and aromatase inhibitors for chemoprevention of invasive breast cancer got clearer with data from extended follow-up coming in. Interestingly, sometimes the longer duration studies confirm earlier findings, and sometimes they do not – and researchers end up reaching new conclusions, Dr. Banu Arun of the University of Texas MD Anderson Cancer Center in Houston explained at the annual Miami Breast Cancer Conference, held by Physicians’ Education Resource.

Although not everyone agrees, Dr. Arun said why she believes there is still a role for chemoprevention of invasive breast cancer. In cases where studies do not point to a clear-cut difference in survival outcomes between agents, she recommends physicians select therapy based on other risks, benefits, and other considerations.

Technology also presents a challenge. Advances in next generation sequencing, for example, allow physicians to order a test for up to 25 genetic mutations associated with breast cancer. Compared with earlier assays that only tested for well-known risk factors like BRCA 1 and BRCA 2, these panels can return results where the clinical implications remain uncertain, leaving doctors unclear on how to counsel patients.

Dr. Arun had no relevant financial disclosures.

MIAMI BEACH – Despite significant improvements in detection and treatment of contralateral breast cancer, there’s a “huge increase” in the number of women choosing to undergo bilateral mastectomy, Dr. Ann Partridge of Dana-Farber Cancer Institute in Boston said.

Physicians can counsel patients that the risk of cancer recurrence in the body elsewhere is more of a concern than a new breast cancer, Dr. Partridge said, and provide a realistic picture of the side effects and potential complications of bilateral versus unilateral surgery. Conversations between physicians and patients regarding the pros and cons of more aggressive therapy are essential, she said in a video interview at the annual Miami Breast Cancer Conference, held by Physicians’ Education Resource.

Some ethical considerations arise when counseling younger women with a genetic mutation that raises the risk of breast cancer (for example, BRCA1 or BRCA2), especially when they plan to undergo in vitro fertilization and pre-implantation embryo analysis. Dr. Partridge shares advice on how to help these women make the best decision for them.

Many women diagnosed with breast cancer before age 40 wonder if it’s safe to have a baby, Dr. Partridge said. Ask about intentions to get pregnant at the first visit, she advised, and share data from retrospective outcome comparisons when guiding these women on their options.

Dr. Partridge had no relevant financial disclosures.

MIAMI BEACH – Despite significant improvements in detection and treatment of contralateral breast cancer, there’s a “huge increase” in the number of women choosing to undergo bilateral mastectomy, Dr. Ann Partridge of Dana-Farber Cancer Institute in Boston said.

Physicians can counsel patients that the risk of cancer recurrence in the body elsewhere is more of a concern than a new breast cancer, Dr. Partridge said, and provide a realistic picture of the side effects and potential complications of bilateral versus unilateral surgery. Conversations between physicians and patients regarding the pros and cons of more aggressive therapy are essential, she said in a video interview at the annual Miami Breast Cancer Conference, held by Physicians’ Education Resource.

Some ethical considerations arise when counseling younger women with a genetic mutation that raises the risk of breast cancer (for example, BRCA1 or BRCA2), especially when they plan to undergo in vitro fertilization and pre-implantation embryo analysis. Dr. Partridge shares advice on how to help these women make the best decision for them.

Many women diagnosed with breast cancer before age 40 wonder if it’s safe to have a baby, Dr. Partridge said. Ask about intentions to get pregnant at the first visit, she advised, and share data from retrospective outcome comparisons when guiding these women on their options.

Dr. Partridge had no relevant financial disclosures.

MIAMI BEACH – Despite significant improvements in detection and treatment of contralateral breast cancer, there’s a “huge increase” in the number of women choosing to undergo bilateral mastectomy, Dr. Ann Partridge of Dana-Farber Cancer Institute in Boston said.

Physicians can counsel patients that the risk of cancer recurrence in the body elsewhere is more of a concern than a new breast cancer, Dr. Partridge said, and provide a realistic picture of the side effects and potential complications of bilateral versus unilateral surgery. Conversations between physicians and patients regarding the pros and cons of more aggressive therapy are essential, she said in a video interview at the annual Miami Breast Cancer Conference, held by Physicians’ Education Resource.

Some ethical considerations arise when counseling younger women with a genetic mutation that raises the risk of breast cancer (for example, BRCA1 or BRCA2), especially when they plan to undergo in vitro fertilization and pre-implantation embryo analysis. Dr. Partridge shares advice on how to help these women make the best decision for them.

Many women diagnosed with breast cancer before age 40 wonder if it’s safe to have a baby, Dr. Partridge said. Ask about intentions to get pregnant at the first visit, she advised, and share data from retrospective outcome comparisons when guiding these women on their options.

Dr. Partridge had no relevant financial disclosures.

MIAMI BEACH – Although many women with breast cancer who choose a mastectomy believe they will lower their risk for recurrence, compared with breast conservation therapy, physicians should counsel them about this misperception for most instances, Dr. Mike Dixon said in a video interview at the annual Miami Breast Cancer Conference.

Multiple factors suggest that the risk of cancer recurrence with breast conservation therapy have declined over time. When combined with advances in imaging and gains in systemic therapy and radiation therapy, offering women with early breast cancer a choice between mastectomy and breast conservation may no longer make sense, said Dr. Dixon, professor of surgery at the University of Edinburgh.

More favorable patient outcomes and lower overall costs also favor breast conservation therapy over mastectomy for most women, he explained.

The conference was held by Physicians’ Education Resource. Dr. Dixon has no relevant disclosures.

MIAMI BEACH – Although many women with breast cancer who choose a mastectomy believe they will lower their risk for recurrence, compared with breast conservation therapy, physicians should counsel them about this misperception for most instances, Dr. Mike Dixon said in a video interview at the annual Miami Breast Cancer Conference.

Multiple factors suggest that the risk of cancer recurrence with breast conservation therapy have declined over time. When combined with advances in imaging and gains in systemic therapy and radiation therapy, offering women with early breast cancer a choice between mastectomy and breast conservation may no longer make sense, said Dr. Dixon, professor of surgery at the University of Edinburgh.

More favorable patient outcomes and lower overall costs also favor breast conservation therapy over mastectomy for most women, he explained.

The conference was held by Physicians’ Education Resource. Dr. Dixon has no relevant disclosures.

MIAMI BEACH – Although many women with breast cancer who choose a mastectomy believe they will lower their risk for recurrence, compared with breast conservation therapy, physicians should counsel them about this misperception for most instances, Dr. Mike Dixon said in a video interview at the annual Miami Breast Cancer Conference.

Multiple factors suggest that the risk of cancer recurrence with breast conservation therapy have declined over time. When combined with advances in imaging and gains in systemic therapy and radiation therapy, offering women with early breast cancer a choice between mastectomy and breast conservation may no longer make sense, said Dr. Dixon, professor of surgery at the University of Edinburgh.

More favorable patient outcomes and lower overall costs also favor breast conservation therapy over mastectomy for most women, he explained.

The conference was held by Physicians’ Education Resource. Dr. Dixon has no relevant disclosures.

SAN FRANCISCO – Successful outcomes in 74 of 79 patients who underwent robotic-assisted thymectomy suggest that the technology is safe and feasible, results of a multicenter European study demonstrate.

Dr. Franca Melfi, of the University of Pisa in Italy, reported on 79 patients with early thymoma who were surgically treated at multiple centers in Europe between 2002 and 2011. More than half, 45 patients, had myasthenia gravis. At last follow-up, 74 patients were still alive and free from recurrence. One patient died of a diffuse intrathoracic recurrence and the others died of unrealted causes, she said at the annual meeting of the American Association for Thoracic Surgery.

Improved depth perception and precise movements facilitated by articulated instruments are among the benefits of the robotic approach. The robot facilitates safe access to the thymus in the upper mediastinal area where the space is small and there are numerous vessels. This approach also allows a prolonged thymectomy when removal of all the fat is required, she explained.

The 608 reported robotic-assisted thymectomies worldwide come from 43 papers published since 2003, but most feature a small number of patients and/or a short follow-up, Dr. Melfi said. One of the few larger studies of robotic-assisted thymectomy included 106 patients with myasthenia gravis (Ann. N.Y. Acad. Sci. 2008;1132:329-35). Researchers in this prospective study reported a mean operative time of 186 minutes, a 1% conversion rate, and a 30-day mortality of 0%. They had a low overall postoperative morbidity rate (2 of 95 patients): one instance of bleeding and one nerve injury.

A greater than 40% complete and stable remission rate for myasthenia gravis was "a real interesting result," Dr. Melfi said, noting that mean follow-up was 20 months. Most participants reported improved quality of life, she added.

Additional clinical experience and refinements are warranted, Dr. Melfi said, acknowledging the need for prospective, randomized trials.

Dr. Melfi reported no conflicts.☐

SAN FRANCISCO – Successful outcomes in 74 of 79 patients who underwent robotic-assisted thymectomy suggest that the technology is safe and feasible, results of a multicenter European study demonstrate.

Dr. Franca Melfi, of the University of Pisa in Italy, reported on 79 patients with early thymoma who were surgically treated at multiple centers in Europe between 2002 and 2011. More than half, 45 patients, had myasthenia gravis. At last follow-up, 74 patients were still alive and free from recurrence. One patient died of a diffuse intrathoracic recurrence and the others died of unrealted causes, she said at the annual meeting of the American Association for Thoracic Surgery.

Improved depth perception and precise movements facilitated by articulated instruments are among the benefits of the robotic approach. The robot facilitates safe access to the thymus in the upper mediastinal area where the space is small and there are numerous vessels. This approach also allows a prolonged thymectomy when removal of all the fat is required, she explained.

The 608 reported robotic-assisted thymectomies worldwide come from 43 papers published since 2003, but most feature a small number of patients and/or a short follow-up, Dr. Melfi said. One of the few larger studies of robotic-assisted thymectomy included 106 patients with myasthenia gravis (Ann. N.Y. Acad. Sci. 2008;1132:329-35). Researchers in this prospective study reported a mean operative time of 186 minutes, a 1% conversion rate, and a 30-day mortality of 0%. They had a low overall postoperative morbidity rate (2 of 95 patients): one instance of bleeding and one nerve injury.

A greater than 40% complete and stable remission rate for myasthenia gravis was "a real interesting result," Dr. Melfi said, noting that mean follow-up was 20 months. Most participants reported improved quality of life, she added.

Additional clinical experience and refinements are warranted, Dr. Melfi said, acknowledging the need for prospective, randomized trials.

Dr. Melfi reported no conflicts.☐

SAN FRANCISCO – Successful outcomes in 74 of 79 patients who underwent robotic-assisted thymectomy suggest that the technology is safe and feasible, results of a multicenter European study demonstrate.

Dr. Franca Melfi, of the University of Pisa in Italy, reported on 79 patients with early thymoma who were surgically treated at multiple centers in Europe between 2002 and 2011. More than half, 45 patients, had myasthenia gravis. At last follow-up, 74 patients were still alive and free from recurrence. One patient died of a diffuse intrathoracic recurrence and the others died of unrealted causes, she said at the annual meeting of the American Association for Thoracic Surgery.

Improved depth perception and precise movements facilitated by articulated instruments are among the benefits of the robotic approach. The robot facilitates safe access to the thymus in the upper mediastinal area where the space is small and there are numerous vessels. This approach also allows a prolonged thymectomy when removal of all the fat is required, she explained.

The 608 reported robotic-assisted thymectomies worldwide come from 43 papers published since 2003, but most feature a small number of patients and/or a short follow-up, Dr. Melfi said. One of the few larger studies of robotic-assisted thymectomy included 106 patients with myasthenia gravis (Ann. N.Y. Acad. Sci. 2008;1132:329-35). Researchers in this prospective study reported a mean operative time of 186 minutes, a 1% conversion rate, and a 30-day mortality of 0%. They had a low overall postoperative morbidity rate (2 of 95 patients): one instance of bleeding and one nerve injury.

A greater than 40% complete and stable remission rate for myasthenia gravis was "a real interesting result," Dr. Melfi said, noting that mean follow-up was 20 months. Most participants reported improved quality of life, she added.

Additional clinical experience and refinements are warranted, Dr. Melfi said, acknowledging the need for prospective, randomized trials.

Dr. Melfi reported no conflicts.☐

SAN FRANCISCO – Successful outcomes in 74 of 79 patients who underwent robotic-assisted thymectomy suggest that the technology is safe and feasible, results of a multicenter European study demonstrate.

Dr. Franca Melfi, of the University of Pisa in Italy, reported on 79 patients with early thymoma who were surgically treated at multiple centers in Europe between 2002 and 2011. More than half, 45 patients, had myasthenia gravis. At last follow-up, 74 patients were still alive and free from recurrence. One patient died of a diffuse intrathoracic recurrence and the others died of unrealted causes, she said at the annual meeting of the American Association for Thoracic Surgery.

Improved depth perception and precise movements facilitated by articulated instruments are among the benefits of the robotic approach. The robot facilitates safe access to the thymus in the upper mediastinal area where the space is small and there are numerous vessels. This approach also allows a prolonged thymectomy when removal of all the fat is required, she explained.

The 608 reported robotic-assisted thymectomies worldwide come from 43 papers published since 2003, but most feature a small number of patients and/or a short follow-up, Dr. Melfi said. One of the few larger studies of robotic-assisted thymectomy included 106 patients with myasthenia gravis (Ann. N.Y. Acad. Sci. 2008;1132:329-35). Researchers in this prospective study reported a mean operative time of 186 minutes, a 1% conversion rate, and a 30-day mortality of 0%. They had a low overall postoperative morbidity rate (2 of 95 patients): one instance of bleeding and one nerve injury.

A greater than 40% complete and stable remission rate for myasthenia gravis was "a real interesting result," Dr. Melfi said, noting that mean follow-up was 20 months. Most participants reported improved quality of life, she added.

Additional clinical experience and refinements are warranted, Dr. Melfi said, acknowledging the need for prospective, randomized trials.

Dr. Melfi reported no conflicts.☐

SAN FRANCISCO – Successful outcomes in 74 of 79 patients who underwent robotic-assisted thymectomy suggest that the technology is safe and feasible, results of a multicenter European study demonstrate.

Dr. Franca Melfi, of the University of Pisa in Italy, reported on 79 patients with early thymoma who were surgically treated at multiple centers in Europe between 2002 and 2011. More than half, 45 patients, had myasthenia gravis. At last follow-up, 74 patients were still alive and free from recurrence. One patient died of a diffuse intrathoracic recurrence and the others died of unrealted causes, she said at the annual meeting of the American Association for Thoracic Surgery.

Improved depth perception and precise movements facilitated by articulated instruments are among the benefits of the robotic approach. The robot facilitates safe access to the thymus in the upper mediastinal area where the space is small and there are numerous vessels. This approach also allows a prolonged thymectomy when removal of all the fat is required, she explained.

The 608 reported robotic-assisted thymectomies worldwide come from 43 papers published since 2003, but most feature a small number of patients and/or a short follow-up, Dr. Melfi said. One of the few larger studies of robotic-assisted thymectomy included 106 patients with myasthenia gravis (Ann. N.Y. Acad. Sci. 2008;1132:329-35). Researchers in this prospective study reported a mean operative time of 186 minutes, a 1% conversion rate, and a 30-day mortality of 0%. They had a low overall postoperative morbidity rate (2 of 95 patients): one instance of bleeding and one nerve injury.

A greater than 40% complete and stable remission rate for myasthenia gravis was "a real interesting result," Dr. Melfi said, noting that mean follow-up was 20 months. Most participants reported improved quality of life, she added.

Additional clinical experience and refinements are warranted, Dr. Melfi said, acknowledging the need for prospective, randomized trials.

Dr. Melfi reported no conflicts.☐

SAN FRANCISCO – Successful outcomes in 74 of 79 patients who underwent robotic-assisted thymectomy suggest that the technology is safe and feasible, results of a multicenter European study demonstrate.

Dr. Franca Melfi, of the University of Pisa in Italy, reported on 79 patients with early thymoma who were surgically treated at multiple centers in Europe between 2002 and 2011. More than half, 45 patients, had myasthenia gravis. At last follow-up, 74 patients were still alive and free from recurrence. One patient died of a diffuse intrathoracic recurrence and the others died of unrealted causes, she said at the annual meeting of the American Association for Thoracic Surgery.

Improved depth perception and precise movements facilitated by articulated instruments are among the benefits of the robotic approach. The robot facilitates safe access to the thymus in the upper mediastinal area where the space is small and there are numerous vessels. This approach also allows a prolonged thymectomy when removal of all the fat is required, she explained.

The 608 reported robotic-assisted thymectomies worldwide come from 43 papers published since 2003, but most feature a small number of patients and/or a short follow-up, Dr. Melfi said. One of the few larger studies of robotic-assisted thymectomy included 106 patients with myasthenia gravis (Ann. N.Y. Acad. Sci. 2008;1132:329-35). Researchers in this prospective study reported a mean operative time of 186 minutes, a 1% conversion rate, and a 30-day mortality of 0%. They had a low overall postoperative morbidity rate (2 of 95 patients): one instance of bleeding and one nerve injury.

A greater than 40% complete and stable remission rate for myasthenia gravis was "a real interesting result," Dr. Melfi said, noting that mean follow-up was 20 months. Most participants reported improved quality of life, she added.

Additional clinical experience and refinements are warranted, Dr. Melfi said, acknowledging the need for prospective, randomized trials.

Dr. Melfi reported no conflicts.☐