Transsternal thymectomy is safe and effective for patients with myasthenia gravis at any stage of the disease, according to Dr. Hassan Kattach of Radcliffe Infirmary, Oxford, England, and associates.
Dr. Kattach and his associates assessed outcomes in 85 consecutive patients who underwent transsternal thymectomy at their institution between 1987 and 1998.
Most of the patients chose surgery because their symptoms were refractory to all other treatment. The mean age at surgery was 31 years (range, 11–74 years), and mean follow-up was 5 years.
Transsternal thymectomy was performed through a full sternotomy. The resection borders were the thyroid gland above, the diaphragm below, and the phrenic nerves laterally. This resection is more extensive than that with standard transsternal thymectomy but less extensive than that with aggressive, extended transsternal thymectomy advocated by some clinicians, the investigators said (Ann. Thorac. Surg. 2006;81:305–8).
There were no patient deaths perioperatively or during follow-up. Of the patients, 67 reported clinical improvement, and 63 became asymptomatic or achieved clinical stage I disease with no or minimal treatment required. This included 15 patients who achieved complete stable remission. After the surgery, 13 patients reported no symptom improvement.
Patients who had more advanced disease preoperatively showed the greatest improvement after the surgery.
Complications developed in 13 patients, including 8 patients with major operative complications. These were related to advanced thymomas that required extensive dissection and included two cases of phrenic nerve palsy in patients whose thymomas involved the phrenic nerves.
Neither improvement nor clinical remission were predicted by patient age, gender, duration of disease, or thymic pathology. As such, these factors should not be considered as indications or contraindications to the procedure, Dr. Kattach and associates wrote. Some clinicians have questioned the role of thymectomy in patients who show no evidence of thymoma on chest imaging, but these results show that the presence or absence of thymoma should not influence the decision to do the surgery.