Effectiveness of thymectomy in non-thymomatous myasthenia gravis: a systematic review

Abstract

There is continuous debate regarding the effectiveness of thymectomy in the treatment of non-thymomatous myasthenia gravis (MG). This systematic review was undertaken to determine whether thymectomy was effective in non-thymomatous MG. We retrieved articles published between January 1980 and September 2013. Sixteen cohort studies were included. Given the considerable heterogeneity, we used a descriptive method instead of statistical synthesis. The median relative rates (RRs) and their interquartile ranges were used to estimate the magnitude of benefit. Compared to conservatively treated MG patients, thymectomized patients had higher survival, clinical remission, pharmacologic remission and improvement rates, and RRs were 1.07 (1.01-1.17), 1.83 (0.82-2.99), 1.55 (1.22-1.95) and 1 (1.00-1.09), respectively. Subgroup analyses showed that patients with moderate to severe generalized MG benefited more from thymectomy, with RRs of survival and pharmacologic remission increasing to 1.35 (1.24-1.49) and 2.68 (1.73-4.17), respectively. These results suggested that thymectomy might be an effective procedure in non-thymomatous MG patients. The patients with moderate to severe generalized MG might benefit more. Taking into account the poor methodological quality of present studies, more well-designed prospective randomized controlled trials (RCTs) are still required to reach unequivocal conclusion.

Videothoracoscopic Thymectomy for the Treatment of Myasthenia Gravis

“…Con raras excepciones, todos los pacientes con MG con timoma deben someterse a cirugía para extirpar el tumor. La eliminación del timoma se realiza para librar al paciente del tumor y puede no producir una mejora en la MG (11)(12)(13) .…”

“…En esta cohorte también se requirió una dosis más baja de prednisona durante el período de 3 años. Tampoco hubo diferencias complicaciones asociados al tratamiento entre los dos grupos (7,9,13) .…”

Miastenia gravis: resultados inmediatos y alejados de la timectomía transesternal extendida

“…Al observar las características de nuestra serie, estas fueron mayoritariamente mujeres jóvenes, con miastenia generalizada (clasificación IIA-IIB de Osserman) que no superaban los 3 años en promedio de evolución de la MG al momento de la cirugía, similar a lo observado en la literatura internacional 20,[27][28][29][30][31] .…”

“…Los resultados inmediatos obtenidos fueron satisfactorios al no registrarse mortalidad inmediata, con una baja morbilidad, semejante a los observado en otras publicaciones donde la mortalidad peri-operatoria es de 0%-1%, con tasa de complicaciones que van desde 6% hasta 33% 20,[28][29][30][31] .…”

Autoimmune spontaneous chronic urticaria and generalized myasthenia gravis in a patient with polyglandular autoimmune syndrome type 3

“…Removal of the thymus is an effective therapeutic approach in selected patients. Thymectomy is performed in patients with thymoma, but there is continuous debate regarding the effectiveness of thymectomy in the treatment of non‐thymomatous MG . The severity of generalized MG and the presence of multiple endocrine and non‐endocrine autoimmune disorders prompted us to perform thymectomy .…”