Thymectomy in Myasthenia Gravis

Abstract

In recent years, thymectomy has become a widespread procedure in the treatment of myasthenia gravis (MG). Likelihood of remission was highest in preoperative mild disease classification (Osserman classification 1, 2A). In absence of thymoma or hyperplasia, there was no relationship between age and gender in remission with thymectomy. In MG treatment, randomized trials that compare conservative treatment with thymectomy have started, recently. As with non-randomized trials, remission with thymectomy in MG treatment was better than conservative treatment with only medication. There are four major methods for the surgical approach: transcervical, minimally invasive, transsternal, and combined transcervical transsternal thymectomy. Transsternal approach with thymectomy is the accepted standard surgical approach for many years. In recent years, the incidence of thymectomy has been increasing with minimally invasive techniques using thoracoscopic and robotic methods. There are not any randomized, controlled studies which are comparing surgical techniques. However, when comparing non-randomized trials, it is seen that minimally invasive thymectomy approaches give similar results to more aggressive approaches.Keywords: Extended thymectomy, follow-up, myasthenia gravis, thoracoscopic thymectomy ÖZ Miyastenia gravis tedavisinde son yıllarda timektomi giderek yaygınlaşan bir prosedür haline geldi. Preoperatif hafif hastalık sınıflaması (Osserman sınıflaması 1, 2A) olanlarda remisyon ihtimali en yüksek olarak gösterildi. Timoma veya hiperplazi yokluğunda timektomi ile remisyon sağlamada yaş ve cinsiyetin ilişkisi gösterilemedi. Miyastenia gravis tedavisinde timektomi ile konservatif tedaviyi karşılatıran randomize çalışmalar yeni yayınlanmaya başlandı. Nonrandomize çalışmalarda olduğu gibi Miyastenia gravis tedavisinde timektomi ile remisyon, sadece ilaçla konservatif tedaviden daha iyi bulundu. Cerrahi yaklaşım için transservikal, minimal invaziv, transsternal ve kombine transservikal transsternal timektomi olmak üzere dört major yöntem bulunmaktadır. Transsternal yaklaşımla timektomi yıllardır kabul gören standart cerrahi yaklaşımdır. Son yıllarda torakoskopik ve robotik yöntemin kullanıldığı minimal invaziv tekniklerle timektomi sıklığı artmaktadır. Cerrahi teknikleri karşılaştıran randomize, kontrollü çalışmalar bulunmamaktadır. Ancak nonrandimize çalışmalar arasındaki karşılaştırmalara bakıldığında minimal invaziv timektomi yaklaşımlarının daha agresif yaklaşımlara benzer sonuçlar verdiği görülmektedir.

Safety and feasibility of video assisted thoracoscopic thymectomy for myasthenia gravis: a single centre experience

“…Many studies have reported full recovery rate of 20 to 55% after thymectomy Seyfari et al reported full recovery in 34%, partial recovery in 51% and no improvement in 14.9%. [11][12][13] Slightly lower complete recovery rate observed in our study may because of shorter follow up period of 12.5 months, which is the limitation of the present study. Longer follow up is required to evaluate long term therapeutic effect of VATS thymectomy in patients of MG.…”

Mucosa-associated lymphoid tissue lymphoma of the accessory parotid gland presenting as a simple cheek mass

“…[1,3,9] In our case report, the patient had a history of an autoimmune disease (i.e., MG) and thymectomy. [10] This history of chronic inflammation is thought to have induced lymphoid tissue proliferation, leading to the development of lymphoma.…”

Unexpected dislocation following accurate total hip arthroplasty caused by excessive hip joint laxity during myasthenic crisis: a case report

“…However, in the case of anti-cholinesterase therapy failure, corticosteroid therapy or thymectomy are the next most commonly used approaches. In recent years, regardless of MG status, patients who also present with thymoma are advised to undergo resection [ 3 ]. Treatment of myasthenic crisis has been performed using systemic steroid pulse therapy [ 1 – 3 ].…”

“…In recent years, regardless of MG status, patients who also present with thymoma are advised to undergo resection [ 3 ]. Treatment of myasthenic crisis has been performed using systemic steroid pulse therapy [ 1 – 3 ]. However, systemic corticosteroid pulse therapy may increase risk of adverse events including ONFH.…”