Impact of minimally invasive trans-cervical thymectomy on outcome in patients with myasthenia gravis.
OBJECTIVE
To study the impact of minimally invasive trans-cervical thymectomy on the incidence of remission of patients with myasthenia gravis (MG) in a single institution over a 10-year period.


METHODS
A total of 120 consecutive patients referred for video-assisted trans-cervical thymectomy between 1991 and 2000 were included in the analysis. Complete remission was defined as no symptoms and no treatment for 6 months, and remission as minimal ocular symptoms (slight ptosis) or treatment with pyridostigmine only for 6 months.


RESULTS
There were 86 females and 34 males with a median age of 33 (range 14-79) and 36 years (range 12-68), respectively. Symptoms of MG lasted between 2 months and 17 years before thymectomy (median 10 months). Surgery was converted to a partial upper sternotomy in 23 cases (19%). The median hospital stay decreased from 2 days (range 1-8) before 1994 to 1 day (range 1-8) thereafter (p<0.0001). Postoperative complications occurred in four patients (3.3%). After a median follow-up of 48 months (range 6-117 months), 50% of the patients were in complete remission (41%) or in remission (9%). Kaplan-Meier estimates rate of complete remission were 30% after 5 years of follow-up and 91% after 10 years.


CONCLUSIONS
Minimally invasive trans-cervical thymectomy can be performed with short hospital stay and low morbidity, and achieve excellent durable results at 10 years.
Division of Thoracic Surgery, Toronto General Hospital, University Health Network, University of Toronto, Ontario, Toronto, Canada.
Marc
M
de Perrot
Vera
V
Bril
Karen
K
McRae
Shaf
S
Keshavjee
D000328:Adult; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009157:Myasthenia Gravis / Q000601:surgery*; D019990:Perioperative Care / Q000379:methods; D012074:Remission Induction; D012307:Risk Factors; D020775:Thoracic Surgery, Video-Assisted / Q000379:methods*; D013934:Thymectomy / Q000379:methods*; D016896:Treatment Outcome