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Ann Thorac Surg 2003;76:1-3
© 2003 The Society of Thoracic Surgeons

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Editorial

Thymectomy for myasthenia gravis: evaluation requires controlled prospective studies

^a Department of Surgery, Columbia Presbyterian Medical Center, New York, New York, USA
^b Department of Neurology, Haukeland Hospital, University of Bergen, Bergen, Norway
^c Department of Neurology, Case Western Reserve University, Cleveland, Ohio, USA
^d Department of Neurology, University of Virginia, Charlottesville, Virginia, USA
^e Duke University Medical Center, Durham, North Carolina, USA

^* Address reprint requests to Dr Jaretzki, 21 Little Point St, PO Box 365, Essex, CT 06426-0365, USA.
e-mail: alfred.jaretzki@snet.net

The first 20% of the full text of this article appears below.

It is generally believed that a total thymectomy is indicated when thymectomy is used to treat autoimmune nonthymomatous myasthenia gravis (MG) and the best available data, albeit retrospective, suggest that the more complete the resection the better the results (Fig 1) [1, 2]. However, there are no controlled prospective studies that determined unequivocally which thymectomy technique gives the best results, nor even that the entire thymus needs to be removed. In recent issues of this journal, there are two additional reports describing the results of two thymectomy techniques that are used in the treatment of MG.

View larger version (19K): [in this window] [in a new window]   Fig 1. Remission rates (life-table analysis) after four thymectomy techniques for nonthymomatous myasthenia gravis. These are the only life-table analyses available at this time. The data suggest that the more extensive the resection, the better the results. Importantly, however, the studies are uncontrolled and retrospective, and baseline characteristics are not uniform. Controlled prospective studies are required for a valid comparison of two or more thymectomy resectional techniques. (Cervical + Sternal = [T-4 CPMC "Maximal"] the combined transcervical and transsternal "maximal" thymectomy [21]; Sternal = [T-3a/b Stand/Extend] Lindberg’s transsternal thymectomy, more extensive than the standard transsternal thymectomy [T-3a] but less extensive than the aggressive extended transsternal thymectomy [T-3b] [22]; Cervical = [T-1b Extend] the Cooper type "extended" transcervical thymectomy [3]; Cervical = [T-1a Basic] the original Papatestas basic transcervical thymectomy [23]; Spontaneous = spontaneous remissions in children [24]. (Reprinted from Jaretzki A III, The Neurologist; 2003;9:77–99, . . . [Full Text of this Article]

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