Extended transsternal thymectomy for myasthenia gravis: a report of 19 consecutive cases (original) (raw)

Thirteen years follow-up after radical transsternal thymectomy for myasthenia gravis. Do short-term results predict long-term outcome?1

European Journal of Cardio-Thoracic Surgery, 2002

Objective: Long-term evaluation of efficacy and quality of life after radical surgical approach for myasthenia gravis (MG). Comparison between short-term follow-up and long-term outcome. Methods: All patients (n ¼ 26, 16 men and 10 women, mean age: 40.7 years) underwent total transsternal thymectomy for MG between 1986 and 1989. Prospective analysis of the patients for short-term follow-up (mean 22.4 months) was published in 1991. The same group of patients was reevaluated in 2001 (range of follow-up 11.4-15.2 years) and assessed according to the classification of Osserman and Oosterhuis. Results: Mean follow-up was 13.0 years (range 11.4-15.2 years). Two patients were lost from follow-up and one died 4 years after thymectomy for reasons unrelated to MG (n ¼ 23). No early or late postoperative mortality was observed. One sternal osteomyelitis occurred. Late postoperative morbidity included sternal instabilities (n ¼ 2), mild residual thoracic pain (n ¼ 6), and hypertrophic scars (n ¼ 7). Five patients were rehospitalized for aggravating MG and needed plasmapheresis (n ¼ 3) and intubation (n ¼ 1). Thirteen patients (56.5%) showed objective clinical improvement, including six patients (26.1%) with complete remission. Eleven patients (47.8%) do not take any medication at all. Because some late relapse may occur several years after operation, the rate of improvement decreased slightly, whereas the difference between short and long-term follow-up was not statistically significant (P ¼ 0:405). Twenty patients (87%) returned to work, including part-time occupation (n ¼ 4). Fourteen patients (61%) are performing sports regularly. Conclusions: Our data confirm that radical, transsternal thymectomy is an effective and safe therapeutic modality for MG. Short-term results seem to deteriorate over time, therefore long-term studies for minimally invasive approaches have to prove equal results before replacing the standard procedure.

Predictors of clinical outcome following extended thymectomy in myasthenia gravis

European Journal of Cardio-thoracic Surgery, 2003

Objective: Thymectomy remains as the optimal treatment of choice in patients with myasthenia gravis (MG), however, the selection criteria for surgery remains controversial. Methods: We examined the data charts of patients with MG underwent extended thymectomy. We investigated the possible correlations between the clinicopathologic features and clinical outcomes, and analyzed the data to clarify the effect of prognostic factors on clinical outcome. Results: A total of 61 patients with a mean age of 35.8^12.2 years (range, 13-66 years) were analyzed. The overall improvement/remission and clinical worsening rates were 81.9 and 18.1%, respectively. Ossermann stage (P ¼ 0:011) and presence of mediastinal ectopic thymic tissue (P ¼ 0:007) showed a significant correlation with the clinical outcome. Multivariate analysis confirmed Ossermann stage (P ¼ 0:0158), and presence of mediastinal ectopic thymic tissue (P ¼ 0:0100) as independent predictors on clinical outcome. Conclusion: Ossermann stage and the presence of mediastinal ectopic thymic tissue are potential predictors on clinical outcome in patients with MG undergoing extended thymectomy. q

Thymectomy for Myasthenia Gravis: Prognostic Factors in 70 Patients

Asian Cardiovascular and Thoracic Annals, 2007

Thymectomy has become increasingly accepted as an effi cacious procedure for myasthenia gravis, with high rates of complete clinical remission. Predictors of the response to thymectomy for myasthenia gravis vary in the literature. We retrospectively reviewed the clinical records of 70 patients (63% female; mean age, 38 years) diagnosed with myasthenia gravis from August 1993 to August 2004, to determine the factors predicting outcome. Complications occurred in 20%, but there was no hospital mortality. Complete clinical remission was obtained postoperatively in 47%.

The long term experience of thymectomy for myasthenia gravis

Journal of Neurology, Neurosurgery & Psychiatry, 1985

A retrospective survey of the records of 287 patients with generalised myasthenia gravis treated at New End Hospital and later at the Royal Free Hospital by anticholinesterase drugs, with or without thymectomy, between the years 1942 and 1976, shows that 62% of patients were improved. The timing of the operation, the grading of disease and the age and sex of the patient did not greatly influence overall results. The poor prognosis of thymic tumours was confirmed in this series. A decrease occurred in the number of patients achieving complete remission after 1961, although the proportion of patients improving did not fall. It is possible that anticholinesterase therapy may alter the response to thymectomy.

Prognostic Factors of Thymectomy in Patients with Myasthenia Gravis

Annals of the New York Academy of Sciences, 2003

To identify the response to thymectomy and the factors associated with a poor response, a nested case-control study was performed on 132 patients with an established diagnosis of myasthenia gravis who had had a thymectomy between 1987 and 1997 and had been followed up for at least 3 years. Methods: In order to assess the response to thymectomy, the following two points were taken into account: (a) the dose of pyridostigmine and other drugs (steroids, azathioprine) that the patient took before and after thymectomy, and (b) the Osserman classification before and after thymectomy. The patients were divided into 4 groups: (1) patients in remission; (2) patients with improvement; (3) patients with no change, and (4) patients who were worse. Results: 91 patients had a good response (69%) and 41 patients had a poor response (31%). The response by

Predictors of Outcome for Myasthenia Gravis after Thymectomy

The aim of this study was to assess the clinical outcome of patients with myasthenia gravis treated with maximal thymectomy and to identify prognostic variables that predict the outcome. Over 15 years, from 1986 to 2001, we collected data on 100 patients with myasthenia gravis who underwent maximal thymectomy and retrospectively reviewed their outcome. Women comprised 63% and the median age was 25 years (range, 4 to 61). The median duration of the disease was 26 months (range, 1 to 240). According to the Osserman classification, there were seven patients in class I, 31 in class II, 47 in class III, and 15 in class IV. In non thymomatous patients (93 patients), complete remission rate progressively increased from 37.4% to 58.2% and 75% at 3, 10 and 15 years of follow-up respectively. These findings suggest that the complete remission rate is prone to increase with time after maximal thymectomy. The total benefit rate achieved was estimated to be 86% while 14% did not improve at a mean follow-up period of 7.6 years (range, 8 to 180 months). Univariate analysis ( p < 0.05) showed that age, thymic histology and ectopic thymic tissue are significant prognostic factors for outcome.

Clinical outcome of thymectomy in myasthenia gravis patients: A report from Iran

Iranian journal of neurology, 2018

Myasthenia gravis (MG) is an autoimmune disease affecting acetylcholine postsynaptic receptor of voluntary muscles. Thymectomy is done in these patients and is a mainstay in the treatment of MG; however, the long-term result of surgery is still controversial. This study dealt with the investigation of the results of thymectomy in treatment, recovery and control of the symptoms of these patients. This study was performed through a retrospective method in patients suffering from MG who underwent trans-sternal thymectomy between 2011 and 2016. We conducted thymectomy, excision of mediastinal mass and contents of tissues between the right and left phrenic nerves for all patients. Then, the effect of various variables including age, sex, time interval between onset of disease and surgery, thymus pathology and the dosage of drug on clinical response after surgery was determined using various statistical tests. 47 patients including 26 men and 21 women with the mean age of 33.0 ± 4.6 years...

Thymectomy for myasthenia gravis: a 27-year experience 1

2010

Objective: Thymectomy is considered an effective therapeutic option for patients with myasthenia gravis (MG). We reviewed our 27year experience with surgical treatment of MG with respect to long-term results and factors affecting outcome. Methods: Between 1970 and 1997, we performed 232 thymectomies for MG. Fifteen patients were lost to follow-up; the remaining 217 form the object of our study. Sixty-two patients (28.4%) had thymoma. Myasthenia was graded according to a modified Osserman classification: 51 patients (23.5%) were in class I, 81(37.3%) in class IIA, 52 (24%) in class IIB, 26 (12%) in class III and seven (3.2%) in class IV. Mean duration of symptoms before the operation was 12 ± 10 months. Fifty-eight thymectomies for thymoma were performed through a median sternotomy and four through a clamshell incision. Forty-six thymectomies for non-thymomatous MG were performed through a standard cervicotomy, 101 procedures through a partial upper sternal-splitting incision and eight through a complete median sternotomy. Results: Operative mortality was 0.92% (two patients). After a mean follow-up of 119 months, 71% of all patients improved their clinical status (25% without medications and asymptomatic; 46% with a reduction of medications and/or clinically improved); 39 (18%) have a stable disease with no clinical modifications; 12 (5%) presented a deterioration of their clinical status with worse symptoms, required more medications, or both. Thirteen patients (6%) died because of MG (mean survival 34.3 ± 3.6 months). The presence of a thymoma negatively influenced the prognosis. Younger patients showed a more favorable outcome as well as patients with a shorter duration of symptoms before the operation; patients with lower classes of myasthenia showed a higher rate of remission. Conclusions: Thymectomy is effective in the management of patients with MG at all stages with low morbidity. Patients with thymoma present a less favorable outcome.