Complications and Efficacy of Transsternal Thymectomy in Myasthenia Gravis

Abstract

Between January 1977 and September 1985, 75 patients in our department underwent elective surgery for myasthenia gravis through a median sternotomy. The main prerequisite was optimal stabilization by medical treatment with the best possible vital capacity. The Osseman types were as follows: type I (22), type IIa (19), type IIb (26), type III (7), and type IV (1). All patients, except for 3 who were mechanically ventilated for a few hours after surgery, were immediately extubated at the end of the operation. The most frequent histologic finding was thymic hyperplasia (36%); 21.3% of the patients had thymomas. No surgery-related deaths occurred. Wound healing was impaired in 6.7% of the patients, including one patient with complete sternal instability, while 5.3% developed pneumonia. The most serious complications were myasthenic (9.3%) and cholinergic (2.7%) crises. Paresis of the phrenic (2.7%) and recurrent laryngeal (1.3%) nerves occurred only in the thymoma patients, who also had a higher frequency of all other complications. The effect on the myasthenic symptoms 3 months after surgery was as follows: 7.5% of the patients were in complete remission, 61.2% had improved, 9% had deteriorated. In a logistic regression model, the parameters age, sex, duration of disease, Osserman type, histology, pre-operative antibody titer to acetylcholine receptors, and post-operative change in titer were examined with respect to their influence on the effect of surgery. Only thymic histology had an appreciable influence (p = 0.057). The effect of these parameters on the success of surgery as well as the type and frequency of complications in relation to perioperative procedure are discussed in detail.

Factors Influencing Improvement and Remission Rates after Thymectomy for Myasthenia gravis

“…2). In contrast to our experience and that of others [5, 9, 14, 15, 16, 17], several authors found a significant trend towards a greater remission rate in patients with a shorter duration of symptoms and/or an early age at the time of surgery [6, 11, 12, 18, 19, 20]. The majority of these series contained few or no patients with thymoma [6, 12, 18, 19].…”

“…Although some authors found better results in young [6, 12, 22, 23]and/or female [9, 23]patients, the majority found no influence of these two factors [5, 7, 8, 9, 10, 11, 14, 15, 16, 17, 18, 19]. Therefore, sex, age and other factors such as the presence of acetylcholine receptor antibody [22]or the presence of other autoimmune disorders [23]are less likely to influence the rate of improvement after thymectomy and should not intervene with the decision to perform thymectomy.…”

Morbidity After Transsternal Thymectomy for Myasthenia Gravis: A Changing Perspective?

“…Only infrequentl y has minor morbidity been deta iled (15)(16)(17), In recent studies, no mortality was encounte red. irrespect ive of surgical app roach (6 -17).…”

Timectomia estendida por cirurgia torácica videoassistida e cervicotomia no tratamento da miastenia

“…Há relatos dessa complicação nas cirurgias transcervicais (32) e por esternotomia. (33) Bulkley et al, (20) realizando timectomia "máxima" por cervicoesternotomia, relataram três pacientes com disfonia persistente e um com transitória. O controle clínico fácil observado em 90,4% dos casos, após média de 39,2 meses de acompanhamento, demonstra resultados animadores do método.…”