Thymectomy for NonthymomatousMyasthenia Gravis

Abstract

There continues to be debate concerning which thymectomy technique is the procedure of choice in the treatment of nonthymomatous myasthenia gravis (MG). The debate persists primarily because of the lack of controlled prospective studies but also because of the varying presentations and clinical courses of MG patients. Analysis has been complicated by the absence, until very recently, of accepted objective definitions of severity of the illness and response to therapy as well as variable patient selection, timing of surgery, type of surgery, and methods of analysis of results. Without resolution of these issues by properly designed prospective studies, there can be no unequivocally valid comparison of the various thymectomy techniques. In this review, attempts have been made to clarify some of the controversial issues concerning the selection of a thymectomy technique in the treatment of nonthymomatous MG and to make limited recommendations based on the best available evidence.

Myasthenia Gravis

“…The need for prospective clinical studies is increasingly being recognized [34]. A current international multicenter prospective single-blind study has been designed to address the efficacy of thymectomy in anti-AChR seropositive patients treated with prednisone only [34][35][36][37][38]. No evidence is available regarding the role of thymectomy in patients with anti-MuSK seropositive or purely ocular MG.…”

“…Surgery is performed via three major approaches-transcervical, transsternal, and videoendoscopic-with marked variability of the extent of the resection. There are no controlled, randomized clinical trials comparing the extended or limited versions of these techniques in terms of postoperative complications, length of hospital stay, time to remission, or clinical improvement [35][36][37][38]. Controversy remains regarding the age of the patients who benefit from surgery.…”

Robot-assisted thymectomy is superior to transsternal thymectomy

“…Several reports on the use of the da Vinci robotic system for thymectomy show that robotic thymectomy is safe in patients with thymoma and myasthenia gravis [8][9][10][11][12][13][14][15][16][17][18]. Cakar et al [12] compared transsternal thymectomy with robotic thymectomy in 19 patients with myasthenia gravis.…”

Thymectomy in Myasthenia Gravis

“…Mediastinal and cervical adipose tissues may contain varying amounts of thymic tissues in addition to itself [20]. Surgical approach should provide as much resection as possible for this ectopic thymic tissue without damaging recurrent laryngeal, left vagus, and phrenic nerves.…”

“…While thymectomy may be beneficial in patients with the generalized disease, some clinics do not recommend thymectomy for patients with ocular MG [20]. In some clinics, it is recommended as a treatment option with less invasive procedures.…”