Advertisement

Thymectomy is more effective than conservative treatment for myasthenia gravis regarding outcome and clinical improvement

Published:February 09, 2009DOI:https://doi.org/10.1016/j.surg.2008.11.009

      Background

      Myasthenia gravis (MG) is an autoimmune disease with a tremendous impact on the quality of life. Controversies over which patients should be operated on because they may benefit most from thymectomy are still ongoing. The aim of this study was to report our long-term results of patients with MG with comparison of thymectomy and conservative treatment.

      Methods

      We report a series of 252 patients with MG. Survival data were generated. Patients were seen in the outpatient clinic, where a modified Osserman score and quality of life score were evaluated at the end of the follow-up period for all surviving patients.

      Results

      A total of 172 patients with MG were followed after thymectomy or with conservative treatment for a median time of 9.8 years. Patients who underwent thymectomy had significantly greater rates of remission and improvement compared with conservative treatment. Furthermore, they had a significantly greater survival.

      Conclusion

      Currently, different effective modalities of treatment are available in patients with MG. In our long-term follow-up, thymectomy was superior to conservative treatment regarding overall survival, clinical improvement, and remission rate. Therefore, thymectomy should be considered strongly for all patients with generalized MG.
      To read this article in full you will need to make a payment
      Subscribe to Surgery
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Weigert C.
        Pathologisch-anatomischer beitrag zur erbschen krankheit.
        Neurolo Zentralbl. 1901; 20 ([Myasthenia gravis]): 597-601
        • Pascuzzi R.M.
        The history of myasthenia gravis.
        Neurol Clin. 1994; 12: 231-242
        • Kirschner P.A.
        Alfred Blalock and thymectomy for myasthenia gravis.
        Ann Thorac Surg. 1987; 43: 348-349
        • Slater G.
        • Papatestas A.E.
        • Genkins G.
        • Kornfeld P.
        • Horowitz S.H.
        • Bender A.
        Thymomas in patients with myasthenia gravis.
        Ann Surg. 1978; 188: 171-174
        • Hassantash S.A.
        • Ashbaugh D.G.
        • Verrier E.D.
        • Maier R.V.
        Surgical treatment of myasthenia gravis in two major Middle East teaching hospitals: factors influencing outcome.
        Thorax. 1996; 51: 193-196
        • Papatestas A.E.
        • Genkins G.
        • Kornfeld P.
        • Eisenkraft J.B.
        • Fagerstrom R.P.
        • Pozner J.
        • et al.
        Effects of thymectomy in myasthenia gravis.
        Ann Surg. 1987; 206: 79-88
        • Hassel B.
        • Gilhus N.E.
        • Aarli J.A.
        • Skogen O.R.
        Fulminant myasthenia gravis and polymyositis after thymectomy for thymoma.
        Acta Neurol Scand. 1992; 85: 63-65
        • Jaretzki III, A.
        • Penn A.S.
        • Younger D.S.
        • Wolff M.
        • Olarte M.R.
        • Lovelace R.E.
        • et al.
        “Maximal” thymectomy for myasthenia gravis.
        Results. J Thorac Cardiovasc Surg. 1988; 95: 747-757
        • Jaretzki III, A.
        • Bethea M.
        • Wolff M.
        • Olarte M.R.
        • Lovelace R.E.
        • Penn A.S.
        • et al.
        A rational approach to total thymectomy in the treatment of myasthenia gravis.
        Ann Thorac Surg. 1977; 24: 120-130
        • Masaoka A.
        • Nagaoka Y.
        • Kotake Y.
        Distribution of thymic tissue at the anterior mediastinum. Current procedures in thymectomy.
        J Thorac Cardiovasc Surg. 1975; 70: 747-754
        • Bachmann K.
        • Burkhardt D.
        • Schreiter I.
        • Kaifi J.
        • Busch C.
        • Thayssen G.
        • et al.
        Long-term outcome and quality of life after open and thoracoscopic thymectomy for myasthenia gravis.
        Surg Endosc. 2008; 22: 2470-2477
        • Manlulu A.
        • Lee T.W.
        • Wan I.
        • Law C.Y.
        • Chang C.
        • Garzon J.C.
        • et al.
        Video-assisted thoracic surgery thymectomy for nonthymomatous myasthenia gravis.
        Chest. 2005; 128: 3454-3460
        • Aaronson N.K.
        • Ahmedzai S.
        • Bergman B.
        • Bullinger M.
        • Cull A.
        • Duez N.J.
        • et al.
        The European Organization for Research and Treatment of Cancer QLQ-C30: a quality-of-life instrument for use in international clinical trials in oncology.
        J Natl Cancer Inst. 1993; 85: 365-376
        • Busch C.
        • Machens A.
        • Pichlmeier U.
        • Emskotter T.
        • Izbicki J.R.
        Long-term outcome and quality of life after thymectomy for myasthenia gravis.
        Ann Surg. 1996; 224: 225-232
        • Machens A.
        • Busch C.
        • Emskotter T.
        • Izbicki J.R.
        Morbidity after transsternal thymectomy for myasthenia gravis: a changing perspective?.
        Thorac Cardiovasc Surg. 1998; 46: 37-40
        • Bril V.
        • Kojic J.
        • Ilse W.K.
        • Cooper J.D.
        Long-term clinical outcome after transcervical thymectomy for myasthenia gravis.
        Ann Thorac Surg. 1998; 65: 1520-1522
        • Blossom G.B.
        • Ernstoff R.M.
        • Howells G.A.
        • Bendick P.J.
        • Glover J.L.
        Thymectomy for myasthenia gravis.
        Arch Surg. 1993; 128: 855-862
        • DeFilippi V.J.
        • Richman D.P.
        • Ferguson M.K.
        Transcervical thymectomy for myasthenia gravis.
        Ann Thorac Surg. 1994; 57: 194-197
        • Jaretzki III, A.
        • Barohn R.J.
        • Ernstoff R.M.
        • Kaminski H.J.
        • Keesey J.C.
        • Penn A.S.
        • et al.
        Myasthenia gravis: recommendations for clinical research standards. Task Force of the Medical Scientific Advisory Board of the Myasthenia Gravis Foundation of America.
        Ann Thorac Surg. 2000; 70: 327-334
        • Oosterhuis H.J.
        The natural course of myasthenia gravis: a long term follow up study.
        J Neurol Neurosurg Psychiatry. 1989; 52: 1121-1127
        • Oosterhuis H.J.
        The ocular signs and symptoms of myasthenia gravis.
        Doc Ophthalmol. 1982; 52: 363-378
        • Roth T.
        • Ackermann R.
        • Stein R.
        • Inderbitzi R.
        • Rosler K.
        • Schmid R.A.
        Thirteen years follow-up after radical transsternal thymectomy for myasthenia gravis. Do short-term results predict long-term outcome?.
        Eur J Cardiothorac Surg. 2002; 21: 664-670
        • Mulder D.G.
        • Herrmann Jr, C.
        • Keesey J.
        • Edwards H.
        Thymectomy for myasthenia gravis.
        Am J Surg. 1983; 146: 61-66
        • Schumpelick V.
        • Janzen R.W.
        Dtsch Med Wochenschr. 1984; 109 ([Thymectomy in myasthenia gravis]): 1166-1172
        • McQuillen M.P.
        • Leone M.G.
        A treatment carol: thymectomy revisited.
        Neurology. 1977; 27: 1103-1106
        • Werneck L.C.
        • Cunha F.M.
        • Scola R.H.
        Myasthenia gravis: a retrospective study comparing thymectomy to conservative treatment.
        Acta Neurol Scand. 2000; 101: 41-46
        • Zielinski M.
        • Kuzdzal J.
        • Szlubowski A.
        • Soja J.
        Comparison of late results of basic transsternal and extended transsternal thymectomies in the treatment of myasthenia gravis.
        Ann Thorac Surg. 2004; 78: 253-258
        • Buckingham J.M.
        • Howard Jr, F.M.
        • Bernatz P.E.
        • Payne W.S.
        • Harrison Jr, E.G.
        • O'Brien P.C.
        • et al.
        The value of thymectomy in myasthenia gravis: a computer-assisted matched study.
        Ann Surg. 1976; 184: 453-458
        • Mulder D.G.
        • Herrmann C.
        • Buckberg G.D.
        Effect of thymectomy in patients with myasthenia gravis. A sixteen year experience.
        Am J Surg. 1974; 128: 202-206
        • Mulder D.G.
        • Graves M.
        • Herrmann C.
        Thymectomy for myasthenia gravis: recent observations and comparisons with past experience.
        Ann Thorac Surg. 1989; 48: 551-555
        • Papatestas A.E.
        • Genkins G.
        • Kornfeld P.
        Comparison of the results of the transcervical and transsternal thymectomy in myasthenia gravis.
        Ann N Y Acad Sci. 1981; 377: 766-778
        • Bril V.
        • Kojic J.
        • Ilse W.K.
        • Cooper J.D.
        Long-term clinical outcome after transcervical thymectomy for myasthenia gravis.
        Ann Thorac Surg. 1998; 65: 1520-1522
        • Otto T.J.
        • Strugalska H.
        Surgical treatment for myasthenia gravis.
        Thorax. 1987; 42: 199-204
        • Shrager J.B.
        • Deeb M.E.
        • Mick R.
        • Brinster C.J.
        • Childers H.E.
        • Marshall M.B.
        • et al.
        Transcervical thymectomy for myasthenia gravis achieves results comparable to thymectomy by sternotomy.
        Ann Thorac Surg. 2002; 74: 320-326
        • de P.M.
        • Bril V.
        • McRae K.
        • Keshavjee S.
        Impact of minimally invasive trans-cervical thymectomy on outcome in patients with myasthenia gravis.
        Eur J Cardiothorac Surg. 2003; 24: 677-683
        • Sugarbaker D.J.
        Thoracoscopy in the management of anterior mediastinal masses.
        Ann Thorac Surg. 1993; 56: 653-656
        • Landreneau R.J.
        • Dowling R.D.
        • Castillo W.M.
        • Ferson P.F.
        Thoracoscopic resection of an anterior mediastinal tumor.
        Ann Thorac Surg. 1992; 54: 142-144
        • Kay R.
        • Lam S.
        • Wong K.S.
        • Wang A.
        • Ho J.
        Response to thymectomy in Chinese patients with myasthenia gravis.
        J Neurol Sci. 1994; 126: 84-87
        • Mack M.J.
        • Landreneau R.J.
        • Yim A.P.
        • Hazelrigg S.R.
        • Scruggs G.R.
        Results of video-assisted thymectomy in patients with myasthenia gravis.
        J Thorac Cardiovasc Surg. 1996; 112: 1352-1359
        • Toker A.
        • Eroglu O.
        • Ziyade S.
        • Tanju S.
        • Senturk M.
        • Dilege S.
        • et al.
        Comparison of early postoperative results of thymectomy: partial sternotomy vs videothoracoscopy.
        Thorac Cardiovasc Surg. 2005; 53: 110-113
        • Manlulu A.
        • Lee T.W.
        • Wan I.
        • Law C.Y.
        • Chang C.
        • Garzon J.C.
        • et al.
        Video-assisted thoracic surgery thymectomy for nonthymomatous myasthenia gravis.
        Chest. 2005; 128: 3454-3460
        • Yim A.P.
        • Kay R.L.
        • Ho J.K.
        Video-assisted thoracoscopic thymectomy for myasthenia gravis.
        Chest. 1995; 108: 1440-1443
        • Bril V.
        • Kojic J.
        • Ilse W.K.
        • Cooper J.D.
        Long-term clinical outcome after transcervical thymectomy for myasthenia gravis.
        Ann Thorac Surg. 1998; 65: 1520-1522
        • Zielinski M.
        • Kuzdzal J.
        • Szlubowski A.
        • Soja J.
        Comparison of late results of basic transsternal and extended transsternal thymectomies in the treatment of myasthenia gravis.
        Ann Thorac Surg. 2004; 78: 253-258
        • Cooper J.D.
        • Al-Jilaihawa A.N.
        • Pearson F.G.
        • Humphrey J.G.
        • Humphrey H.E.
        An improved technique to facilitate transcervical thymectomy for myasthenia gravis.
        Ann Thorac Surg. 1988; 45: 242-247
        • Bril V.
        • Kojic J.
        • Ilse W.K.
        • Cooper J.D.
        Long-term clinical outcome after transcervical thymectomy for myasthenia gravis.
        Ann Thorac Surg. 1998; 65: 1520-1522
        • Blossom G.B.
        • Ernstoff R.M.
        • Howells G.A.
        • Bendick P.J.
        • Glover J.L.
        Thymectomy for myasthenia gravis.
        Arch Surg. 1993; 128: 855-862
        • Tsuchida M.
        • Yamato Y.
        • Souma T.
        • Yoshiya K.
        • Watanabe T.
        • Aoki T.
        • et al.
        Efficacy and safety of extended thymectomy for elderly patients with myasthenia gravis.
        Ann Thorac Surg. 1999; 67: 1563-1567
        • Lopez-Cano M.
        • Ponseti-Bosch J.M.
        • Espin-Basany E.
        • Sanchez-Garcia J.L.
        • Armengol-Carrasco M.
        Clinical and pathologic predictors of outcome in thymoma-associated myasthenia gravis.
        Ann Thorac Surg. 2003; 76: 1643-1649