[Thymectomy for myastenia gravis: 25-year experience].
OBJECTIVE
Thymectomy is considered an effective therapeutic option for patients with myasthenia gravis (MG). We reviewed our 25-years experience with surgical treatment of MG with respect to long-term results and factors affecting outcome.


METHODS
Between 1978 and 2002, we performed 232 thymectomies for MG. Fifteen patients were lost to follow-up; the remaining 217 form the object of our study. 32 patients (28.4%) had thymoma. Myasthenia was graded according to a modified Osserman classification: 51 patients (23.5%) were in class I, 81 (37.3%) in class IIA, 52 (24%) in class IIB, 26 (12%) in class III and seven (3.2%) in class IV. Mean duration of symptoms before the operation was 14 +/- 10 months. Fifty-eight thymectomies for thymoma were performed through a median sternotomy and four through a clamshell incision. Forty-six thymectomies for non-thymomatous MG were performed through a standard cervicotomy, 155 procedures through a partial upper sternal-splitting incision and eight through a complete median sternotomy.


RESULTS
Operative mortality was 0.92% (two patients). After a mean follow-up of 119 months, 77% of all patients improved their clinical status (26% without medications and asymptomatic; 45% with a reduction of medications and/or clinically improved); 39 (18%) have a stable disease with no clinical modifications; 12 (5%) presented a deterioration of their clinical status with worse symptoms, required more medications, or both. Thirteen patients (6%) died because of MG (mean survival 34.3 +/- 3.6 months). The presence of a thymoma negatively influenced the prognosis. Younger patients showed a more favorable outcome as well as patients with a shorter duration of symptoms before the operation; patients with lower classes of myasthenia showed a higher rate of remission.


CONCLUSIONS
Thymectomy is effective in the management of patients with MG at all stages with low morbidity. Patients with thymoma present a less favorable outcome.
Petkov
R
R
Kŭtev
N
N
Mladenovski
V
V
Todorov
G
G
Gavrilov
N
N
Atanasov
A
A
Goranov
N
N
D000328:Adult; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009157:Myasthenia Gravis / Q000175:diagnosis / Q000401:mortality / Q000601:surgery*; D012189:Retrospective Studies; D012720:Severity of Illness Index; D016019:Survival Analysis; D013934:Thymectomy / Q000401:mortality; D013950:Thymus Gland / Q000601:surgery*; D016896:Treatment Outcome