title: Long-term outcome and quality of life after open and thoracoscopic thymectomy for myasthenia gravis: analysis of 131 patients.
abstract: BACKGROUND
  Myasthenia gravis is an autoimmune disease with a great impact on quality of life. Besides conservative treatment with mestinon and immunosuppressive medication, thymectomy is an established intervention that offers substantial improvements of the disease. Since the past decade, minimally invasive procedures have been performed. This study aimed to report on the long-term results for all the patients who underwent thymectomy for myasthenia gravis, paying special attention to postoperative disease-related outcome, quality of life, and differences regarding the operative approach.
  
  
  METHODS
  This report describes a series of 131 patients with generalized myasthenia gravis who underwent thymectomy between 1980 and 2005. The clinical course data during the hospitalization and consultation in our outpatient clinic were reviewed, and survival data were generated. The patients were seen in the outpatient clinic, where a modified Osserman and quality-of-life score was evaluated at the end of the follow-up period for all surviving patients.
  
  
  RESULTS
  A total of 106 patients with myasthenia gravis were followed up after thymectomy for a median time of 8 years (range, 1-27 years). Eight patients died during this period. The perioperative mortality rate was 0%, and the morbidity rate was 19.8%. The patients with thymoma and a high preoperative Osserman score had a significantly shorter survival. With minimally invasive procedures, the hospital stay was significantly shorter, and the rate for improvement of myasthenia gravis-associated symptoms was significantly higher. The rate of perioperative complications and myasthenia-related complications during the follow-up period showed no significant differences.
  
  
  CONCLUSIONS
  Transsternal and minimally invasive thymectomy contribute to an improvement in myasthenia gravis symptoms for all subgroups. Surgery can be performed with low individual risks. In our trial, minimally invasive surgery was found to be superior in terms of improvement in myasthenia gravis-associated symptoms. Additionally, the hospital stay was shorter, and the patients felt less disturbed by direct effects of the operation. Therefore, minimally invasive thymectomy can be regarded as the treatment of choice for patients undergoing surgery for myasthenia gravis.
authors.affiliation: Department of General, Visceral, and Thoracic Surgery, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany.
authors.forename: Kai
authors.initials: K
authors.lastname: Bachmann
authors.forename: Doreen
authors.initials: D
authors.lastname: Burkhardt
authors.forename: Inken
authors.initials: I
authors.lastname: Schreiter
authors.forename: Jussuf
authors.initials: J
authors.lastname: Kaifi
authors.forename: Christoph
authors.initials: C
authors.lastname: Busch
authors.forename: Gunther
authors.initials: G
authors.lastname: Thayssen
authors.forename: Jakob R
authors.initials: JR
authors.lastname: Izbicki
authors.forename: Tim
authors.initials: T
authors.lastname: Strate
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016009:Chi-Square Distribution; D002648:Child; D005260:Female; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D009157:Myasthenia Gravis / Q000601:surgery*; D011379:Prognosis; D016016:Proportional Hazards Models; D011788:Quality of Life; D018709:Statistics, Nonparametric; D013906:Thoracoscopy / Q000379:methods*; D013934:Thymectomy / Q000379:methods*; D016896:Treatment Outcome