title: Matched-pair comparison of three different approaches for thymectomy in myasthenia gravis.
abstract: BACKGROUND
  Because of the lack of evidence-based data comparing different techniques for thymectomy (Thx), a matched-pair study was conducted to evaluate the role of thoracoscopic Thx (tThx) more objectively.
  
  
  METHODS
  Of 182 patients who underwent Thx, 3 groups according to the operation technique were matched for myasthenia gravis (MG) without thymoma, age, gender, and severity of MG. Twenty patients each who had Thx through anterolateral thoracotomy (aThx), extended median sternotomy (sThx), and tThx were compared for length of operation, postoperative morbidity, complete remission, quantification of improvement of MG, and cosmetic results.
  
  
  RESULTS
  Complete tThx required 197 +/- 35 min as compared to 113 +/- 43 min for sThx and 82 +/- 27 min for aThx (P <0.001). With zero mortality the overall postoperative morbidity rate was 25% for sThx versus 15% for aThx and 5% for tThx (P <0.05). There was no difference in complete remission of MG. The median activities of daily living (ADL) scores improved by 6.0 (1-19) after tThx, 5.5 (2-4) after sThx, and 7.5 (0-12) after aThx. Best cosmetic results were achieved after tThx.
  
  
  CONCLUSIONS
  There was adequate cumulative medium-term improvement of MG and less postoperative morbidity after tThx, which may become the preferred technique for Thx.
authors.affiliation: Department of General, Visceral, Thoracic, and Vascular Surgery, Humboldt University Medical School (Charité), Campus Mitte, Berlin, Germany. jens-c.rueckert@charite.de
authors.forename: J C
authors.initials: JC
authors.lastname: Rückert
authors.forename: H K
authors.initials: HK
authors.lastname: Sobel
authors.forename: S
authors.initials: S
authors.lastname: Göhring
authors.forename: K M
authors.initials: KM
authors.lastname: Einhäupl
authors.forename: J M
authors.initials: JM
authors.lastname: Müller
mesh_terms: D000328:Adult; D019317:Evidence-Based Medicine; D005260:Female; D006801:Humans; D008297:Male; D016555:Matched-Pair Analysis; D009157:Myasthenia Gravis / Q000150:complications / Q000601:surgery*; D012189:Retrospective Studies; D012720:Severity of Illness Index; D013906:Thoracoscopy / Q000009:adverse effects / Q000379:methods; D013934:Thymectomy / Q000009:adverse effects / Q000379:methods*; D013945:Thymoma / Q000473:pathology