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Ann Thorac Surg 2001;72:197-202
© 2001 The Society of Thoracic Surgeons

Original article: general thoracic

Predictors of outcome in thymectomy for myasthenia gravis

Jason M. Budde, MDa, Cullen D. Morris, MDa, Anthony A. Gal, MDb, Kamal A. Mansour, MDa, Joseph I. Miller, Jr, MDa a Division of Cardiothoracic Surgery, Joseph B. Whitehead Department of Surgery, Emory University School of Medicine, Atlanta, Georgia, USA
b Department of Pathology and Laboratory Medicine, Emory University School of Medicine, Atlanta, Georgia, USA

Address reprint requests to Dr Miller, Division of Cardiothoracic Surgery, Emory University, The Emory Clinic, Building A, 1365 Clifton Rd, Atlanta, GA 30322
e-mail: jmille{at}aol.com

Presented at the Forty-seventh Annual Meeting of the Southern Thoracic Surgical Association, Marco Island, FL, Nov 9–11, 2000.

Background. Factors determining predictability of response to thymectomy for myasthenia gravis (MG) vary in the literature.

Methods. A 25-year retrospective review (1974 to 1999) of all thymectomies performed at a single institution was undertaken.

Results. In 113 consecutive thymectomies for MG, women comprised 79% (89 of 113 patients), and mean age was 40 ± 15 years. Complications occurred in 14% of patients (16 of 113). In-hospital mortality was 0, but 90-day hospital mortality was 0.88% (1 of 113 patients). Follow-up was obtained in 81% (92 of 113 patients) at a mean of 51 ± 59 months postoperatively. Complete remission was achieved in 21% of patients (19 of 92), and marked improvement of MG in 54% (50 of 92), for a total benefit rate of 75%. Fourteen percent (13 of 92) were unchanged, and 11% (10 of 92) were worse. Using univariate analysis, sex, age, and pathology correlated significantly with outcome (p < 0.05): 80% of women (57 of 70) benefited from the procedure, versus 57% of men (12 of 21). Eighty percent (57 of 70) of patients less than 51 years of age were improved or in remission, versus 57% (12 of 22) older than 50. Twenty-three percent (5 of 22) of patients with thymoma deteriorated, versus 7.1% (5 of 70) without thymoma. Sex did not significantly correlate in the multivariate model.

Conclusions. Sex, age, and thymic pathology are potential predictors of outcome in thymectomy for MG, and may shape treatment decisions and target higher-risk patients.




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