Thymectomy in the management of myasthenia gravis.
There continues to be a debate regarding the effectiveness of thymectomy in the treatment of nonthymomatous myasthenia gravis (MG) and, when undertaken, which thymectomy technique is the procedure of choice. The debate persists primarily because of the lack of controlled prospective studies. Analysis has been complicated by the absence, until very recently, of accepted objective definitions of severity of the illness and response to therapy as well as variable patient selection, timing of surgery, type of surgery, and methods of analysis of results. Without resolution of these issues by properly controlled prospective studies, there can be no unequivocal determination of the effectiveness of thymectomy or valid comparison of the various thymectomy techniques. In this review, based on previous analyses, attempts will be made to clarify some of the controversial issues concerning thymectomy for nonthymomatous MG and make limited recommendations based on the best available evidence.
Jaretzki
Alfred
A
Department of Surgery, New York Presbyterian Hospital, Columbia Presbyterian Medical Center, College of Physicians & Surgeons, Columbia University, New York, New York, USA. aj31@columbia.edu
Steinglass
Kenneth M
KM
Sonett
Joshua R
JR
D003627:Data Interpretation, Statistical; D006801:Humans; D008488:Medical Illustration; D009157:Myasthenia Gravis / Q000276:immunology / Q000503:physiopathology / Q000601:surgery*; D018579:Patient Selection; D011446:Prospective Studies; D013934:Thymectomy / Q000379:methods / Q000706:statistics & numerical data* / Q000639:trends; D013950:Thymus Gland / Q000033:anatomy & histology / Q000503:physiopathology / Q000601:surgery; D016896:Treatment Outcome