Benefits of early thymectomy in patients with myasthenia gravis.

OBJECTIVE

To report our experience of early thymectomy in patients with myasthenia gravis.

DESIGN

Retrospective study.

SETTING

University department of surgery, Greece.

SUBJECTS

76 Patients with myasthenia gravis.

INTERVENTIONS

Transcervical thymectomy in all cases, additional left thoracotomy in four cases.

MAIN OUTCOME MEASURES

Mortality, morbidity, and early (6 months) and late (mean follow-up 4.8 years) response to thymectomy.

RESULTS

20 Patients had thymomas (26%). There was no postoperative mortality; morbidity was 11% (n = 8). There was complete remission in 19 (25%), improvement in 49 (65%) no change in 7 (9%), and impairment in 1 (1%) of the patients at 6 months. Patients who had had symptoms for less than 5 years (p < 0.001), were in an earlier stage of disease (p = 0.006), and who did not have thymomas (p = 0.006) responded better. 3 Patients died of invasive thymoma at 2 1/2, 3, and 5 1/2 years postoperatively and 25/76 (33%) were lost to follow-up. Of the 51 patients available for late follow-up, 19 (37%) were in remission, in 26 (51%) the symptoms had improved, 3 (6%) were unchanged, and 3 (6%) had died of the disease.

CONCLUSIONS

Transcervical thymectomy should be considered in patients with early myasthenia gravis.