title: The role of thymectomy in the treatment of juvenile myasthenia gravis: a systematic review.
abstract: BACKGROUND
  The role of thymectomy in the treatment of juvenile myasthenia gravis (JMG) is poorly defined. The objective of this systematic review was to evaluate the effect of thymectomy on survival, disease severity, and peri-operative complications for patients with JMG.
  
  
  METHODS
  A search of MEDLINE, EMBASE, and the Cochrane Library (1/1/2000-3/1/2016) identified all English language, human studies of thymectomy for JMG. The population was patients with JMG age ≤18 years who underwent thymectomy (comparator group was unexposed to thymectomy). Outcomes included survival, disease severity, and post-operative complications. Data extraction was performed by independent reviewers.
  
  
  RESULTS
  Sixteen retrospective studies included 1131 participants with JMG and 488 (43%) underwent thymectomy. Post-operative improvement in JMG severity occurred for 77% (n = 376/488). Comparisons of thymectomy to non-operative management were mixed. Post-operative complications were poorly recorded. Power to compare surgical approaches was limited. Outcomes specific to antibodies, surgical pathology findings, severity of JMG, and timing of thymectomy were sparse.
  
  
  CONCLUSIONS
  Existing data regarding thymectomy for JMG are limited and entirely retrospective. The majority of patients who underwent thymectomy had improvement in disease severity and post-operative complications were rare. Prospective, multicenter study of thymectomy for JMG is warranted.
authors.affiliation: Department of Surgery, Brigham and Women's Hospital and Harvard Medical School, 75 Francis St, CA-034, Boston, MA, 02115, USA. amadenci@partners.org.|Department of Surgery, Boston Children's Hospital and Harvard Medical School, Boston, MA, USA. amadenci@partners.org.
authors.forename: Arin L
authors.initials: AL
authors.lastname: Madenci
authors.affiliation: Department of Surgery, Brigham and Women's Hospital and Harvard Medical School, 75 Francis St, CA-034, Boston, MA, 02115, USA.
authors.forename: George Z
authors.initials: GZ
authors.lastname: Li
authors.affiliation: Department of Surgery, Boston Children's Hospital and Harvard Medical School, Boston, MA, USA.
authors.forename: Brent R
authors.initials: BR
authors.lastname: Weil
authors.affiliation: Department of Surgery, Boston Children's Hospital and Harvard Medical School, Boston, MA, USA.
authors.forename: David
authors.initials: D
authors.lastname: Zurakowski
authors.affiliation: Division of Pediatric Neurology, Department of Pediatrics, University of Florida College of Medicine, Gainesville, FL, USA.
authors.forename: Peter B
authors.initials: PB
authors.lastname: Kang
authors.affiliation: Department of Surgery, Boston Children's Hospital and Harvard Medical School, Boston, MA, USA.
authors.forename: Christopher B
authors.initials: CB
authors.lastname: Weldon
mesh_terms: D006801:Humans; D009157:Myasthenia Gravis / Q000150:complications / Q000401:mortality / Q000601:surgery*; D012720:Severity of Illness Index; D013934:Thymectomy / Q000009:adverse effects
keywords: Autoantibodies; Minimally invasive surgical procedures; Myasthenia gravis; Pediatrics; Systemic review; Thymectomy