Morbidity After Transsternal Thymectomy for Myasthenia Gravis: A Changing Perspective?

Abstract

A detailed assessment of recent changes in morbidity and mortality after transsternal thymectomy for myasthenia gravis is pending. To this end, a retrospective analysis was carried out of morbidity and mortality rates in 125 patients subjected to transsternal thymectomy for myasthenia gravis in the periods 1976-85 (1st decade) and 1986-95 (2nd decade). Composition of patients did not change much over time, except for more concomitant preoperative disease in the second decade (p = 0.001). None the less, complication rates were not higher, nor did the pattern of complications alter. Mortality was nil in both decades. There was no difference over the decades as to length of ventilation, intensive care treatment, or overall hospitalization. Most complications did not reveal a monocausal relationship, suggesting that a combination of risk factors was implicated. Further reductions in future morbidity rates after transsternal thymectomy for myasthenia gravis seem unlikely as patient preoperative state is unlikely to improve. In the light of the deteriorating preoperative patient condition, constant postoperative morbidity rates indicate that patient care has in fact improved.

Matched-pair comparison of three different approaches for thymectomy in myasthenia gravis

“…In particular, there were enough patients who underwent sThx, which is the technique most widely used for MG, or aThx, which is another radical but rarely used approach, to be matched for comparison with the new tThx. The detailed rates of morbidity found in our patients ( Table 2) correlate exactly with the findings of Machens et al investigating morbidity after transsternal Thx for MG [13]. The data are comparable because nearly the same rate of patients received immunosuppression preoperatively.…”

“…4). The median cumulative ADL improvement was 6.0 (1-19) for tThx, 5.5 (2)(3)(4)(5)(6)(7)(8)(9)(10)(11)(12)(13)(14) for sThx, and 7.5 (0-12) for aThx and was thus nearly the same for all groups (Fig. 4).…”

Long-term outcome and quality of life after open and thoracoscopic thymectomy for myasthenia gravis: analysis of 131 patients

“…Additionally, neuroclinical signs were assessed using a modified Osserman classification as follows: 0 (no symptoms) 1 (ocular signs and symptoms), 2 (mild generalized weakness), 3 (moderate weakness), and 4 (severe generalized weakness and/ or respiratory dysfunction). This classification had already been established in previous trials [2][3][4]17]. Changes in myasthenia gravis-associated symptoms after thymectomy were classified according to the DeFilippi classification [8].…”

Prognostic factors for myasthenic crisis after transsternal thymectomy in patients with myasthenia gravis

“…Although the risk of respiratory failure may have been decreased by using less invasive surgical approaches (cervicotomy, [28][29][30] partial sternotomy, 26 or video-assisted thoracoscopic surgery 31,32 ), avoiding myorelaxants and longacting anesthetic agents, and providing adequate postoperative analgesia, 33,34 the accurate incidence rate of postoperative myasthenic crisis was not described in these reports. Contraindications to cervical thymectomy include advanced age, poorly controlled neurologic symptoms, and evidence for a thymoma.…”