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Ann Thorac Surg 2002;74:1658-1662
© 2002 The Society of Thoracic Surgeons
a Divisions of Thoracic Surgery, Toronto General Hospital and Princess Margaret Hospital, University Health Network, University of Toronto, Toronto, Ontario, Canada
b Division ofNeurology, Toronto General Hospital and Princess Margaret Hospital, University Health Network, University of Toronto, Toronto, Ontario, Canada
c DepartmentAnesthesia, Toronto General Hospital and Princess Margaret Hospital, University Health Network, University of Toronto, Toronto, Ontario, Canada
d Department of Radiation Oncology, Toronto General Hospital and Princess Margaret Hospital, University Health Network, University of Toronto, Toronto, Ontario, Canada
* Address reprint requests to Dr Keshavjee, Division of Thoracic Surgery, E10-224, Toronto General Hospital, 200 Elizabeth St, Toronto, M5G2C4 Ontario, Canada.
e-mail: shaf.keshavjee{at}uhn.on.ca
Presented at the Poster Session of the Thirty-eighth Annual Meeting of The Society of Thoracic Surgeons, Fort Lauderdale, FL, Jan 28–30, 2002.
BACKGROUND: The presence of thymoma may be a negative prognostic factor with respect to the outcome of myasthenia gravis (MG).
METHODS: Of 122 consecutive patients with MG undergoing thymectomy between August 1994 and September 2000, 37 had a thymoma. Postoperative radiation was administered to all patients with stage II thymoma and higher. To determine differences in presentation and outcome, thymoma patients were compared with patients with atrophic (n = 49) or hyperplastic (n = 36) thymus gland on final pathology.
RESULTS: Thymoma patients were significantly older (52 ± 14 vs 36 ± 15 years, p < 0.0001) and included a significantly higher proportion of males (54% vs 28%, p = 0.006) than patients without thymoma. However, the preoperative Osserman grade and the duration of symptoms before surgery were not significantly different between groups. Mean follow-up after thymectomy was not significantly different between patients with or without thymoma (32 ± 23 vs 37 ± 19 months, respectively, p = 0.3). At last follow-up, the proportion of asymptomatic patients (63% vs 70%, respectively, p = 0.5) and the mean Osserman grade (0.6 ± 0.9 vs 0.5 ± 0.9, respectively, p = 0.6) were similar in both groups. In addition, the rate of complete remission reached 36% at 5 years in patients with or without thymoma (p = 0.8).
CONCLUSIONS: Although myasthenic patients with thymoma are significantly older and include a greater proportion of males, the overall outcome, including the rate of complete remission, was similar between patients with or without thymoma. Therefore, the presence of a thymoma should not necessarily be viewed as a negative prognostic factor regarding recovery from myasthenia gravis.
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