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Joseph B. Shrager
Maher E. Deeb
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Larry R. Kaiser
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Ann Thorac Surg 2002;74:320-327
© 2002 The Society of Thoracic Surgeons

Original article: general thoracic

Transcervical thymectomy for myasthenia gravis achieves results comparable to thymectomy by sternotomy

Joseph B. Shrager, MD*a, Maher E. Deeb, MDa, Rosemarie Mick, MSb, Clay J. Brinster, BSa, Henry E. Childers, MDa, M. Blair Marshall, MDa, John C. Kucharczuk, MDa, Steven L. Galetta, MDc, Shawn J. Bird, MDc, Larry R. Kaiser, MDa

a Section of General Thoracic Surgery, Division of Cardiothoracic Surgery, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania, USA
b Department of Biostatistics and Epidemiology, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania, USA
c Department of Neurology, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania, USA

* Address reprint requests to Dr Shrager, 4 Fl, Silverstein Bldg, Hospital of the University of Pennsylvania, 3400 Spruce St, Philadelphia, PA 19104 USA
e-mail: jshrag{at}mail.med.upenn.edu

Presented at the Thirty-eighth Annual Meeting of The Society of Thoracic Surgeons, Fort Lauderdale, FL, Jan 28–30, 2002.

Background. It remains controversial whether transcervical thymectomy offers results equivalent to thymectomy by way of a median sternotomy in the treatment of myasthenia gravis. Furthermore, preoperative prognostic factors have not been clearly defined.

Methods. This study is a retrospective chart review and interview of 78 patients completing transcervical thymectomy for myasthenia gravis between 1992 and 1999.

Results. There were 24 men and 54 women. Mean age was 40 years (range, 13 to 78 years). Twelve patients were in Osserman class 1, 25 in class 2, 30 in class 3, and 11 in class 4 (mean, 2.5). There was no perioperative mortality and 6 (7.7%) morbidities. Mean length of stay was 1.5 days and mean follow-up, 54.6 months. The crude cumulative complete remission (asymptomatic off medications for 6 months) rate was 39.7% (n = 31). Only 8 patients (10.3%) failed to improve after transcervical thymectomy. Kaplan-Meier estimates of complete remission were 31% and 43% at 2 and 5 years, respectively. Eight patients with thymoma had a 5-year estimated complete remission rate of 75% in contrast to 43% in 38 patients with thymic hyperplasia and 36% in 32 patients with neither thymoma nor hyperplasia (p = 0.01). Twelve patients with ocular myasthenia had a 5-year estimated complete remission rate of 57%, whereas patients with mild-to-moderate (n = 55) or severe (n = 11) generalized symptoms had 5-year complete remission rates of 43% and 30%, respectively (p = 0.21).

Conclusions. Overall, extended transcervical thymectomy offers results that are comparable to those published for the transsternal procedure. Patients with milder disease (including isolated ocular disease) and taking no preoperative immunosuppressive agents appear to experience higher remission rates. In contrast to previous studies, we also find that small thymomas predict better responses to thymectomy.




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