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Long-term outcome and quality of life after open and thoracoscopic thymectomy for myasthenia gravis: analysis of 131 patients

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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.

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References

  1. Aaronson NK, Ahmedzai S, Bergman B, Bullinger M, Cull A, Duez NJ, Filiberti A, Flechtner H, Fleishman SB, de Haes JC (1993) The European Organization for Research and Treatment of Cancer QLQ-C30: a quality-of-life instrument for use in international clinical trials in oncology. J.Natl Cancer Inst 85:365–376

    Article  PubMed  CAS  Google Scholar 

  2. Blossom GB, Ernstoff RM, Howells GA, Bendick PJ, Glover JL (1993) Thymectomy for myasthenia gravis. Arch Surg 128:855–862

    PubMed  CAS  Google Scholar 

  3. Bril V, Kojic J, Ilse WK, Cooper JD (1998) Long-term clinical outcome after transcervical thymectomy for myasthenia gravis. Ann Thorac Surg 65:1520–1522

    Article  PubMed  CAS  Google Scholar 

  4. Busch C, Machens A, Pichlmeier U, Emskotter T, Izbicki JR (1996) Long-term outcome and quality of life after thymectomy for myasthenia gravis. Ann Surg 224:225–232

    Article  PubMed  CAS  Google Scholar 

  5. Calhoun RF, Ritter JH, Guthrie TJ, Pestronk A, Meyers BF, Patterson GA, Pohl MS, Cooper JD (1999) Results of transcervical thymectomy for myasthenia gravis in 100 consecutive patients. Ann Surg 230:555–559

    Article  PubMed  CAS  Google Scholar 

  6. Cooper JD, Al-Jilaihawa AN, Pearson FG, Humphrey JG, Humphrey HE (1988) An improved technique to facilitate transcervical thymectomy for myasthenia gravis. Ann Thorac Surg 45:242–247

    Article  PubMed  CAS  Google Scholar 

  7. dePerrot M, Bril V, McRae K, Keshavjee S (2003) Impact of minimally invasive transcervical thymectomy on outcome in patients with myasthenia gravis. Eur J Cardiothorac Surg 24:677–683

    Article  Google Scholar 

  8. DeFilippi VJ, Richman DP, Ferguson MK (1994) Transcervical thymectomy for myasthenia gravis. Ann Thorac Surg 57:194–197

    Article  PubMed  CAS  Google Scholar 

  9. Evoli A, Batocchi AP, Provenzano C, Ricci E, Tonali P (1988) Thymectomy in the treatment of myasthenia gravis: report of 247 patients. J Neurol 235:272–276

    Article  PubMed  CAS  Google Scholar 

  10. Hassantash SA, Ashbaugh DG, Verrier ED, Maier RV (1996) Surgical treatment of myasthenia gravis in two major Middle East teaching hospitals: factors influencing outcome. Thorax 51:193–196

    PubMed  CAS  Google Scholar 

  11. Jaretzki A III, Bethea M, Wolff M, Olarte MR, Lovelace RE, Penn AS, Rowland L (1977) A rational approach to total thymectomy in the treatment of myasthenia gravis. Ann Thorac Surg 24:120–130

    Article  PubMed  Google Scholar 

  12. Jaretzki A III, Penn AS, Younger DS, Wolff M, Olarte MR, Lovelace RE, Rowland LP (1988) “Maximal” thymectomy for myasthenia gravis: results. J Thorac Cardiovasc Surg 95:747–757

    PubMed  Google Scholar 

  13. Kay R, Lam S, Wong KS, Wang A, Ho J (1994) Response to thymectomy in Chinese patients with myasthenia gravis. J Neurol Sci 126:84–87

    Article  PubMed  CAS  Google Scholar 

  14. Kirschner PA (1987) Alfred Blalock and thymectomy for myasthenia gravis. Ann Thorac Surg 43:348–349

    Article  PubMed  CAS  Google Scholar 

  15. Landreneau RJ, Dowling RD, Castillo WM, Ferson PF (1992) Thoracoscopic resection of an anterior mediastinal tumor. Ann Thorac Surg 54:142–144

    Article  PubMed  CAS  Google Scholar 

  16. Lopez-Cano M, Ponseti-Bosch JM, Espin-Basany E, Sanchez-Garcia JL, Armengol-Carrasco M (2003) Clinical and pathologic predictors of outcome in thymoma-associated myasthenia gravis. Ann Thorac Surg 76:1643–1649

    Article  PubMed  Google Scholar 

  17. Machens A, Busch C, Emskotter T, Izbicki JR (1998) Morbidity after transsternal thymectomy for myasthenia gravis: a changing perspective? Thorac Cardiovasc Surg 46:37–40

    PubMed  CAS  Google Scholar 

  18. Mack MJ, Landreneau RJ, Yim AP, Hazelrigg SR, Scruggs GR (1996) Results of video-assisted thymectomy in patients with myasthenia gravis. J Thorac Cardiovasc Surg 112:1352–1359

    Article  PubMed  CAS  Google Scholar 

  19. Manlulu A, Lee TW, Wan I, Law CY, Chang C, Garzon JC, Yim A (2005) Video-assisted thoracic surgery thymectomy for nonthymomatous myasthenia gravis. Chest 128:3454–3460

    Article  PubMed  Google Scholar 

  20. Masaoka A, Nagaoka Y, Kotake Y (1975) Distribution of thymic tissue at the anterior mediastinum: current procedures in thymectomy. J Thorac Cardiovasc Surg 70:747–754

    PubMed  CAS  Google Scholar 

  21. Mulder DG, Braitman H, Li W, Herrmann C Jr (1972) Surgical management in myasthenia gravis. J Thorac Cardiovasc Surg 63:109–113

    PubMed  CAS  Google Scholar 

  22. Mulder DG, Graves M, Herrmann C (1989) Thymectomy for myasthenia gravis: recent observations and comparisons with past experience. Ann Thorac Surg 48:551–555

    Article  PubMed  CAS  Google Scholar 

  23. Mulder DG, Herrmann C Jr, Keesey J, Edwards H (1983) Thymectomy for myasthenia gravis. Am J Surg 146:61–66

    Article  PubMed  CAS  Google Scholar 

  24. Nakamura H, Taniguchi Y, Suzuki Y, Tanaka Y, Ishiguro K, Fukuda M, Hara H, Mori T (1996) Delayed remission after thymectomy for myasthenia gravis of the purely ocular type. J Thorac Cardiovasc Surg 112:371–375

    Article  PubMed  CAS  Google Scholar 

  25. Nix WA (1997) Indications and value of thymectomy in myasthenia gravis. Nervenarzt 68:85–93

    Article  PubMed  CAS  Google Scholar 

  26. Oosterhuis HJ (1982) The ocular signs and symptoms of myasthenia gravis. Doc Ophthalmol 52:363–378

    Article  PubMed  CAS  Google Scholar 

  27. Oosterhuis HJ (1989) The natural course of myasthenia gravis: a long-term follow-up study. J Neurol Neurosurg Psychiatry 52:1121–1127

    Article  PubMed  CAS  Google Scholar 

  28. Otto TJ, Strugalska H (1987) Surgical treatment for myasthenia gravis. Thorax 42:199–204

    PubMed  CAS  Google Scholar 

  29. Papatestas AE, Genkins G, Kornfeld P (1981) Comparison of the results of the transcervical and transsternal thymectomy in myasthenia gravis. Ann N Y Acad Sci 377:766–778

    Article  PubMed  CAS  Google Scholar 

  30. Papatestas AE, Genkins G, Kornfeld P, Eisenkraft JB, Fagerstrom RP, Pozner J, Aufses AH Jr (1987) Effects of thymectomy in myasthenia gravis. Ann Surg 206:79–88

    Article  PubMed  CAS  Google Scholar 

  31. Pascuzzi RM (1994) The history of myasthenia gravis. Neurol Clin 12:231–242

    PubMed  CAS  Google Scholar 

  32. Rilling G, Tettenborn B (2001) Therapy of myasthenia gravis. Schweiz Rundsch Med Prax 90:1350–1354

    CAS  Google Scholar 

  33. Roth T, Ackermann R, Stein R, Inderbitzi R, Rosler K, Schmid RA (2002) Thirteen years follow-up after radical transsternal thymectomy for myasthenia gravis: do short-term results predict long-term outcome? Eur J Cardiothorac Surg 21:664–670

    Article  PubMed  CAS  Google Scholar 

  34. Ruckert JC, Walter M, Muller JM (2000) Pulmonary function after thoracoscopic thymectomy versus median sternotomy for myasthenia gravis. Ann Thorac Surg 70:1656–1661

    Article  PubMed  CAS  Google Scholar 

  35. Shrager JB, Deeb ME, Mick R, Brinster CJ, Childers HE, Marshall MB, Kucharczuk JC, Galetta SL, Bird SJ, Kaiser LR (2002) Transcervical thymectomy for myasthenia gravis achieves results comparable to thymectomy by sternotomy. Ann Thorac Surg 74:320–326

    Article  PubMed  Google Scholar 

  36. Slater G, Papatestas AE, Genkins G, Kornfeld P, Horowitz SH, Bender A (1978) Thymomas in patients with myasthenia gravis. Ann Surg 188:171–174

    Article  PubMed  CAS  Google Scholar 

  37. Sugarbaker DJ (1993) Thoracoscopy in the management of anterior mediastinal masses. Ann Thorac Surg 56:653–656

    Article  PubMed  CAS  Google Scholar 

  38. Toker A, Eroglu O, Ziyade S, Tanju S, Senturk M, Dilege S, Kalayci G (2005) Comparison of early postoperative results of thymectomy: partial sternotomy vs videothoracoscopy. Thorac Cardiovasc Surg 53:110–113

    Article  PubMed  CAS  Google Scholar 

  39. Tsuchida M, Yamato Y, Souma T, Yoshiya K, Watanabe T, Aoki T, Hayashi J (1999) Efficacy and safety of extended thymectomy for elderly patients with myasthenia gravis. Ann Thorac Surg 67:1563–1567

    Article  PubMed  CAS  Google Scholar 

  40. Weigert C (1901) Pathologisch-anatomischer Beitrag zur Erb´schen Krankheit (Myasthenia gravis). Neurol Centralbl 20:657–601

    Google Scholar 

  41. Yim AP, Kay RL, Ho JK (1995) Video-assisted thoracoscopic thymectomy for myasthenia gravis. Chest 108:1440–1443

    Article  PubMed  CAS  Google Scholar 

  42. Zielinski M, Kuzdzal J, Szlubowski A, Soja J (2004) Comparison of late results of basic transsternal and extended transsternal thymectomies in the treatment of myasthenia gravis. Ann Thorac Surg 78:253–258

    Article  PubMed  Google Scholar 

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Acknowledgment

The authors thank Suzette Block for her assistance in editing the manuscript. Because standard procedures have been compared, no financial disclosure is necessary.

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Correspondence to Tim Strate.

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Bachmann, K., Burkhardt, D., Schreiter, I. et al. Long-term outcome and quality of life after open and thoracoscopic thymectomy for myasthenia gravis: analysis of 131 patients. Surg Endosc 22, 2470–2477 (2008). https://doi.org/10.1007/s00464-008-9794-2

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