Transsternal maximal thymectomy is effective for extirpation of cervical ectopic thymic tissue in the treatment of myasthenia gravis.
OBJECTIVE
Extensive extirpation of cervico-mediastinal adipose tissue increases the chance of removing ectopic thymic tissues, thus potentially improving the prognosis of myasthenia gravis after thymectomy. We sought to increase efficacy and safety of transsternal maximal thymectomy (TSMT).


METHODS
Twenty four patients who underwent TSMT from July 2006 to June 2007 were retrospectively reviewed and compared with 73 patients who underwent transsternal extended thymectomy (TSET) from January 2004 to May 2006. Ectopic thymic tissue in additionally excised cervicomediastinal fat tissue was examined histologically.


RESULTS
In TSMT group, operation time, amount of cumulative drainage and duration of drainage were significantly higher than TSET group. However, the difference in hemoglobin count, amount of transfusion, duration of intensive care, postoperative hospital stay, and complication rates were not statistically different. There was no operative mortality in either group. Ectopic thymic tissue was found in 50% of patients. All patients had ectopic thymic tissues in the cervical area. Two patients had additional ectopic tissue in the aortopulmonary window, and 1 patient had ectopic tissue at posterior of the left bracheocephalic vein and lateral of the right phrenic nerve.


CONCLUSIONS
TSMT is more effective in the extirpation of ectopic thymic tissues than TSET without significant impairment of safety, especially in the cervical area.
Lee
Chang Young
CY
Department of Thoracic and Cardiovascular Surgery, Yonsei University College of Medicine, 250 Seongsanno, Seodaemun-gu, Seoul 120-752, Korea.
Lee
Jin Gu
JG
Yang
Woo Ik
WI
Haam
Suk Jin
SJ
Chung
Kyung Young
KY
Park
In Kyu
IK
D000273:Adipose Tissue / Q000473:pathology / Q000601:surgery; D000328:Adult; D002828:Choristoma / Q000473:pathology / Q000601:surgery; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009157:Myasthenia Gravis / Q000601:surgery*; D009333:Neck; D012189:Retrospective Studies; D013934:Thymectomy / Q000379:methods*; D013950:Thymus Gland; D055815:Young Adult