title: Extended transcervical thymectomy with partial upper sternotomy: results in non-thymomatous patients with myasthenia gravis.
abstract: OBJECTIVE
  Thymectomy is a recognized treatment for myasthenia gravis (MG), but the optimal surgical approach is yet to be determined. This study analysed the results in non-thymomatous MG patients treated at our institution using an extended transcervical access with partial upper sternotomy (TC-US), in order to describe cumulative incidence of remission and its predictors.
  
  
  METHODS
  In the period 1988-2012, 215 non-thymomatous MG patients underwent thymectomy using the TC-US approach. There were 61 males and 154 females (median age: 33 years). Primary end points were complete stable remission (CSR) and pharmacological remission (PR). Clinico-pathological predictors of CSR/PR were analysed including age, gender, preoperative MG symptom duration, preoperative immunosuppression therapy and disease severity.
  
  
  RESULTS
  The median follow-up period was 127 months. The median preoperative duration of MG symptoms was 9 months (interquartile range 4-13). The median operative time was 65 min (range: 45-135). There was no postoperative death. Morbidity rate was 7% (14 patients, no major complication). Ten patients died at the follow-up (3 of MG). MG symptoms improved in 85% (150/176) of the patients. CSR rate was 34%, PR rate was 4%. Cumulative incidence of CSR/PR was 27, 37 and 46% at 5, 10 and 15 years, respectively. Independent predictors of increased CSR/PR rate were age (P = 0.028) and MG symptom duration <6 months (P = 0.013).
  
  
  CONCLUSIONS
  Our data suggest that in patients with non-thymomatous MG, thymectomy by TC-US has a remission rate not inferior to those reported after trans-sternal or video-assisted thoracic surgery techniques. The short duration of MG symptoms before thymectomy is a predictor of remission. The technique strikes a reasonable balance between the extent of thymic resection, operative and anaesthesia time, patient acceptance, neurological outcome and costs.
authors.affiliation: Division of Thoracic Surgery, University of Torino, Torino, Italy enrico.ruffini@unito.it.
authors.forename: Enrico
authors.initials: E
authors.lastname: Ruffini
authors.affiliation: Division of Thoracic Surgery, University of Torino, Torino, Italy.
authors.forename: Francesco
authors.initials: F
authors.lastname: Guerrera
authors.affiliation: Division of Thoracic Surgery, University of Torino, Torino, Italy.
authors.forename: Pier Luigi
authors.initials: PL
authors.lastname: Filosso
authors.affiliation: Division of Thoracic Surgery, University of Torino, Torino, Italy.
authors.forename: Giulia
authors.initials: G
authors.lastname: Bora
authors.affiliation: Division of Thoracic Surgery, University of Torino, Torino, Italy.
authors.forename: Giulia
authors.initials: G
authors.lastname: Nex
authors.affiliation: Division of Thoracic Surgery, University of Torino, Torino, Italy.
authors.forename: Simone
authors.initials: S
authors.lastname: Gusmano
authors.affiliation: Division of Neurology, University of Torino, Torino, Italy.
authors.forename: Maria Laura
authors.initials: ML
authors.lastname: Giobbe
authors.affiliation: Unit of Cancer Epidemiology and CPO Piedmont, S. Giovanni Battista Hospital, Torino, Italy.
authors.forename: Giovannino
authors.initials: G
authors.lastname: Ciccone
authors.affiliation: Division of Thoracic Surgery, University of Torino, Torino, Italy.
authors.forename: Maria Cristina
authors.initials: MC
authors.lastname: Bruna
authors.affiliation: Division of Thoracic Surgery, University of Torino, Torino, Italy.
authors.forename: Roberto
authors.initials: R
authors.lastname: Giobbe
authors.affiliation: Division of Pulmonology, University of Torino, Torino, Italy.
authors.forename: Paolo
authors.initials: P
authors.lastname: Solidoro
authors.affiliation: Division of Thoracic Surgery, University of Torino, Torino, Italy.
authors.forename: Paraskevas
authors.initials: P
authors.lastname: Lyberis
authors.affiliation: Division of Thoracic Surgery, University of Torino, Torino, Italy.
authors.forename: Alberto
authors.initials: A
authors.lastname: Oliaro
mesh_terms: D000328:Adult; D000367:Age Factors; D005260:Female; D006801:Humans; D008297:Male; D009157:Myasthenia Gravis / Q000601:surgery*; D061646:Operative Time; D012074:Remission Induction; D012720:Severity of Illness Index; D012737:Sex Factors; D056346:Sternotomy / Q000379:methods* / Q000706:statistics & numerical data; D013934:Thymectomy / Q000379:methods* / Q000706:statistics & numerical data; D016896:Treatment Outcome
keywords: Myasthenia gravis; Outcomes; Thymectomy; Thymus