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The Journal of Thoracic and Cardiovascular Surgery, Vol 95, 747-757, Copyright © 1988 by The American Association for Thoracic Surgery and The Western Thoracic Surgical Association
A Jaretzki 3d, AS Penn, DS Younger, M Wolff, MR Olarte, RE Lovelace and LP Rowland
Thymectomy has been shown to be effective in the treatment of myasthenia
gravis. The logical goal of operation has been complete removal of the
thymus, but there has been controversy about the surgical technique and its
relation to results. Surgical-anatomic studies have shown gross and
microscopic thymus widely distributed in the neck and mediastinum. We
believe that an en bloc transcervical- transsternal "maximal" thymectomy is
required to remove all thymic tissue predictably. Ninety-five patients with
generalized myasthenia gravis underwent "maximal" thymectomy consecutively
between 1977 and 1985 and were evaluated 6 months to 89 months after
operation. In Group A (N = 72), myasthenia gravis without thymoma, the
uncorrected data revealed that 96% (69) had benefited from operation: 79%
(57) had no symptoms; 46% (33) were in remission; 33% (24) were symptom
free when receiving minimal doses of pyridostigmine; and none were worse.
Life table analysis yielded a remission rate of 81% at 89 months. In group
B (N = 8), myasthenia gravis without thymoma for which patients underwent
reexploration for incapacitating weakness after earlier transcervical or
transsternal operations, residual thymus was found in all. One patient was
in remission, two were symptom free when receiving medication, one was
unchanged, and none were worse. In group C (N 15), myasthenia gravis and
thymoma, two patients were in remission and nine were symptom free when
receiving medication. Two patients in this group died 2 and 4 years
postoperatively in crisis. Response to thymectomy in group A was greater in
patients with mild myasthenia gravis and may have been better in patients
who had symptoms for less than 60 months preoperatively, but the response
did not depend on age, sex, presence or absence of thymic hyperplasia or
involution, or titers of acetylcholine receptor antibodies. The response to
thymectomy in group B was striking but slower than in group A, perhaps
because symptoms were more severe and of longer duration. The response in
group C was also less good than in group A and proportionately fewer
benefited. These results support the recommendation for thymectomy in the
treatment of patients with generalized myasthenia gravis and indicate the
desirability of a maximal procedure. For persistent or recurrent severe
symptoms after previous transcervical or submaximal transsternal
resections, reoperation by this technique is also recommended.
ARTICLES
"Maximal" thymectomy for myasthenia gravis. Results
Department of Surgery, Columbia-Presbyterian Medical Center, New York, NY 10032.
This article has been cited by other articles:
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J. W. Rubin Invited commentary. Ann. Thorac. Surg., September 1, 2006; 82(3): 1007 - 1008. [Full Text] [PDF]
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R. S Singh, S. K Behera, R. Saji, and R. S Dhaliwal Thymectomy for Myasthenia Gravis: 12-Year Experience Asian Cardiovasc Thorac Ann, December 1, 2003; 11(4): 299 - 303. [Abstract] [Full Text] [PDF]
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M. Lopez-Cano, J. M. Ponseti-Bosch, E. Espin-Basany, J. L. Sanchez-Garcia, and M. Armengol-Carrasco Clinical and pathologic predictors of outcome in Thymoma-Associated myasthenia gravis Ann. Thorac. Surg., November 1, 2003; 76(5): 1643 - 1649. [Abstract] [Full Text] [PDF]
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J. J. Mafe, J. M. G. Caravajal, B. Baschwitz, and J. M. R. Paniagua Bilateral chylothorax after thymectomy via median sternotomy and resolution through conservative treatment Eur. J. Cardiothorac. Surg., September 1, 2003; 24(3): 466 - 468. [Abstract] [Full Text] [PDF]
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A. Jaretzki III, J. A. Aarli, H. J. Kaminski, L. H. Phillips II, and D. B. Sanders Thymectomy for myasthenia gravis: evaluation requires controlled prospective studies Ann. Thorac. Surg., July 1, 2003; 76(1): 1 - 3. [Full Text] [PDF]
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C. F. Bellows, R. S. Hartz, C. Cullinane, and J. D. Pigott Cosmetic approach to anterior mediastinal masses Ann. Thorac. Surg., November 1, 2002; 74(5): 1724 - 1726. [Abstract] [Full Text] [PDF]
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H. Hirabayashi, M. Ohta, M. Okumura, and H. Matsuda Appearance of thymoma 15 years after extended thymectomy for myasthenia gravis without thymoma Eur. J. Cardiothorac. Surg., September 1, 2002; 22(3): 479 - 481. [Abstract] [Full Text] [PDF]
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J. B. Shrager, M. E. Deeb, R. Mick, C. J. Brinster, H. E. Childers, M. B. Marshall, J. C. Kucharczuk, S. L. Galetta, S. J. Bird, and L. R. Kaiser Transcervical thymectomy for myasthenia gravis achieves results comparable to thymectomy by sternotomy Ann. Thorac. Surg., August 1, 2002; 74(2): 320 - 327. [Abstract] [Full Text] [PDF]
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A. Jaretzki III Injury to the phrenic and recurrent nerves needs to be avoided in the performance of thymectomy for myasthenia gravis Ann. Thorac. Surg., August 1, 2002; 74(2): 633 - 633. [Full Text] [PDF]
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J. M. Budde, C. D. Morris, A. A. Gal, K. A. Mansour, and J. I. Miller Jr Predictors of outcome in thymectomy for myasthenia gravis Ann. Thorac. Surg., July 1, 2001; 72(1): 197 - 202. [Abstract] [Full Text] [PDF]
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A. Mussi, M. Lucchi, L. Murri, R. Ricciardi, L. Luchini, and C. A. Angeletti Extended thymectomy in myasthenia gravis: a team-work of neurologist, thoracic surgeon and anaesthesist may improve the outcome Eur. J. Cardiothorac. Surg., May 1, 2001; 19(5): 570 - 575. [Abstract] [Full Text] [PDF]
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E. Pompeo, I. Nofroni, N. Iavicoli, and T. C. Mineo Thoracoscopic completion thymectomy in refractory nonthymomatous myasthenia Ann. Thorac. Surg., September 1, 2000; 70(3): 918 - 923. [Abstract] [Full Text] [PDF]
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 L. Kokontis and L. Gutmann Current Treatment of Neuromuscular Diseases Arch Neurol, July 1, 2000; 57(7): 939 - 943. [Full Text] [PDF]
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T. C. Mineo, E. Pompeo, T. E. Lerut, G. Bernardi, W. Coosemans, and I. Nofroni Thoracoscopic thymectomy in autoimmune myasthenia: results of left-sided approach Ann. Thorac. Surg., May 1, 2000; 69(5): 1537 - 1541. [Abstract] [Full Text] [PDF]
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 G. Roviaro, F. Varoli, O. Nucca, C. Vergani, and M. Maciocco Videothoracoscopic Approach to Primary Mediastinal Pathology Chest, April 1, 2000; 117(4): 1179 - 1183. [Abstract] [Full Text] [PDF]
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P. A. Kirschner Thymectomy for elderly myasthenia gravis patients Ann. Thorac. Surg., January 1, 2000; 69(1): 313 - 314. [Full Text] [PDF]
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V. Bril, J. Kojic, W. K. Ilse, and J. D. Cooper Long-Term Clinical Outcome After Transcervical Thymectomy for Myasthenia Gravis Ann. Thorac. Surg., June 1, 1998; 65(6): 1520 - 1522. [Abstract] [Full Text] [PDF]
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T. C. Mineo, E. Pompeo, V. Ambrogi, G. Bernardi, C. Iani, and A. F. Sabato Video-assisted completion thymectomy in refractory myasthenia gravis J. Thorac. Cardiovasc. Surg., January 1, 1998; 115(1): 252 - 254. [Full Text] [PDF]
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M. J. Mack, R. J. Landreneau, A. P. Yim, S. R. Hazelrigg, and G. R. Scruggs RESULTS OF VIDEO-ASSISTED THYMECTOMY IN PATIENTS WITH MYASTHENIA GRAVIS J. Thorac. Cardiovasc. Surg., November 1, 1996; 112(5): 1352 - 1360. [Abstract] [Full Text]
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A. Masaoka, Y. Yamakawa, H. Niwa, I. Fukai, S. Kondo, M. Kobayashi, Y. Fujii, and Y. Monden Extended Thymectomy for Myasthenia Gravis Patients: A 20-Year Review Ann. Thorac. Surg., September 1, 1996; 62(3): 853 - 859. [Abstract] [Full Text]
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J. A. Swain Myasthenia Gravis Ann. Thorac. Surg., July 1, 1995; 60(1): 223 - 224. [Full Text]
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M. Ashour Prevalence of ectopic thymic tissue in myasthenia gravis and its clinical significance J. Thorac. Cardiovasc. Surg., April 1, 1995; 109(4): 632 - 635. [Abstract] [Full Text]
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