Details

Autor(en) / Beteiligte

• Mineo, Tommaso Claudio, MD
• Ambrogi, Vincenzo, MD, PhD

Titel

Outcomes after thymectomy in class I myasthenia gravis

Ist Teil von

• The Journal of thoracic and cardiovascular surgery, 2013-05, Vol.145 (5), p.1319-1324

Ort / Verlag

United States: Mosby, Inc

Erscheinungsjahr

2013

Quelle

MEDLINE

Beschreibungen/Notizen

• Objective The role of extended thymectomy in the treatment of class I myasthenia gravis is still controversial. This study compared the long-term outcomes of operated and nonoperated patients allocated according to their will. Methods We retrospectively reviewed 47 patients with class I nonthymomatous myasthenia gravis undergoing extended thymectomy between 1980 and 2007. These patients were matched with 62 class I patients who refused surgery and received only pharmacologic therapy. Outcomes were stable remission and clinical or pharmacologic improvement. Predictors of remission were analyzed by Kaplan–Meier and Cox regression. Results We observed low postoperative major morbidity (n = 2; 4.2%) and no perioperative mortality. Heterotopic thymus was found in 22 patients (46%). Twenty-one patients showed active germinal centers, in the heterotopic thymus in 12 patients (57.1%). Thirty operated patients (64%) versus 34 nonoperated patients (55%) achieved stable remission, and 8 patients (17%) versus 5 patients (9%) showed pharmacologic improvement. Nine patients who had no postoperative improvement showed active ectopic thymus. Surgery was a marginal prognosticator ( P  = .053). Early treatment (≤6 months from symptoms onset) was the unique significant prognosticator ( P  = .045), but this was due to the contribution of the operated patients ( P  = .002). Other predictors of remission in the operated group were the absence of ectopic thymus ( P  = .007) with no germinal centers ( P  = .009). No significant predictor of remission was found in the nonoperated group. Conclusions Extended thymectomy achieved a more rapid remission than after nonsurgical treatment of class I myasthenia gravis. Significantly better outcomes resulted when thymectomy was performed within 6 months from the onset of symptoms.