Maastricht UMC+ (MUMC+) is the only Dutch hospital with a multidisciplinary medical and research team that treats patients with thymus disorders, usually using an operating robot. Marcuse is part of this team and has contributed to scientific research at home and abroad for many years. She will present her dissertation on September 16 Clinical care optimization for patients with a thymic tumor about the thymus and defend thymus operations.
Thymus
The thymus is located behind the sternum and is important for the development of the immune system. After puberty, the thymus ‘retires’. The organ that was once so prominent (weighing about 40 grams) shrivels until it is barely visible. However, the pile of thymus cells left behind may increase in size. Then there may be overactivity of the thymus, and sometimes even a tumor.
Robotic surgery of the thymus
Since 2004, patients with thymus disorders have been operated on at the MUMC+ using a surgical robot. To improve care, Marcuse first looked at all the outcomes of recent years, in which more than 400 patients were operated on with this technique in the MUMC+. Because the patients were followed up in their own region after the operation, data from the years after the operation were checked in no fewer than 60 Dutch hospitals.
Muscle disease myasthenia gravis
Myasthenia gravis (MG) is a rare muscle disease that can develop at any age and originates in the thymus gland. MG can lead to double vision, swallowing and speaking problems, in severe cases also to the inability to perform daily activities and even to failure of the respiratory muscles. Marcuse concludes in her research that the surgical technique is easily feasible for patients with MG and in most cases even contributes to improving muscle weakness.
Thymoom
Thymomas are a type of tumor that can arise in the thymus, and are more common in patients with MG. Marcuse and her team found that 11% of patients with a thymoma have subclinical (‘dormant’) MG without experiencing symptoms. Nevertheless, 90% of these patients still developed complaints within a number of years, an important outcome for which it is important to inform these patients in good time. In addition, she concluded that radiotherapy, which is performed in 25% of patients with a thymoma after surgery, needs improvement. Marcuse explains: ‘There is a lack of international guidelines in this area. Small changes in the current way of working can lead to significant treatment implications. For example, we found that it is not only the radiotherapist who has to decide which areas need radiation, but that the surgeon’s vision significantly influences the volume to be treated. Follow-up research is of great importance to make irradiation even more accurate in the future’.
Improving care
Multidisciplinary collaboration in the treatment of patients is very important, concludes Marcuse. With the results of its research, the MUMC+ thymus expertise team is taking an important step towards better thymus care. A guideline has been drawn up for patients who are operated on in the MUMC+, national guidelines are being developed and a national panel has been set up to discuss difficult issues. All these developments will contribute to the even better treatment of patients with thymus disorders. With her research, Marcuse also wants to put rare diseases of the thymus on the map: ‘rare diseases require just as much attention in the healthcare and scientific world as other disorders.’ The physician-researcher is currently specializing as a lung specialist and aspires to follow-up research in the field of (rare) disorders and tumors in the chest.