Thymectomy in severe (Myasthenia Gravis Foundation of America classes IV–V) generalized myasthenia gravis: is the game really worth the candle? A retrospective analysis from a multi-institutional database

Debora Brascia, Marco Lucchi, Vittorio Aprile, Melania Guida, Roberta Ricciardi, Federico Rea, Giovanni Maria Comacchio, Marco Schiavon, Maria Carlotta Marino, Stefano Margaritora, Elisa Meacci, Gregorio Spagni, Amelia Evoli Stampanoni-B, Giulia Lorenzoni, Giulia De Iaco, Angela De Palma, Giuseppe Marulli

Research output: Contribution to journalArticle

Abstract

OBJECTIVES: Total thymectomy in addition to medical treatment is an accepted standard therapy for myasthenia gravis (MG). Patients with severe generalized MG present life-threatening events, poor prognosis and higher risk of postoperative myasthenic crisis. The aim of our study is to investigate neurological and surgical results in patients with Myasthenia Gravis Foundation of America (MGFA) class IV and V MG following thymectomy. METHODS: Data on 76 MG patients with preoperative MGFA classes IV and V who underwent thymectomy were retrospectively collected. Primary end points included short-term surgical outcomes and long-term neurological results including the achievement of complete stable remission and any improvement as defined by MGFA Post-Intervention Status criteria. RESULTS: There were 27 (35.5%) males and 49 (64.5%) females; 53 (69.7%) were classified as MGFA class IV and 23 (30.3%) as class V. Thymectomy was performed through sternotomy in 25 (32.9%) patients, Video-assisted thoracic surgery (VATS) in 5 (6.6%) and Robot-assisted thoracic surgery (RATS) in 46 (60.5%). The median operative time was 120 (interquartile range: 95; 148) min. In-hospital mortality was observed in 1 (1.3%) patient and postoperative complications in 14 (18.4%) patients. The median postoperative hospital stay was 4 (interquartile range: 3; 6) days. Pathological examination revealed 31 (40.8%) thymic hyperplasia/other benign and 45 (59.2%) thymomas. Cumulative complete stable remission and improvement probabilities were 20.6% and 83.7% at 5 years and 66.9% and 97.6% at 10 years, respectively. A significant improvement rate was found in patients with age at the time of thymectomy of <_50 years (P = 0.0236), MGFA class V (P = 0.0154) and acetylcholine receptor antibodies positivity (P = 0.0152). CONCLUSIONS: Thymectomy in patients with severe MG yields good perioperative outcomes and satisfactory long-term neurological improvement, especially for patients younger than 50 years, with MGFA class V and anti-AChR+ MG.
Original languageEnglish
Pages (from-to)N/A-N/A
JournalEuropean Journal of Cardio-thoracic Surgery
Volume63
DOIs
Publication statusPublished - 2023

Keywords

  • Myasthenia Gravis Foundation of America
  • Myasthenia gravis
  • Thymectomy
  • Thymoma

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