Perioperative Outcomes of Thymectomy in Myasthenia Gravis: A Thoracic Surgery Database Analysis

Raja, Shruti; Guptill, Jeffrey T.; McConnell, Alec; Al‐Khalidi, Hussein R.; Hartwig, Matthew G.; Klapper, Jacob A.

doi:10.1016/j.athoracsur.2021.06.071

Cited by 11 publications

(5 citation statements)

References 17 publications

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“…In contrast, a recent study by Raja et al ( 31 ) concluded that more information is needed to confirm that the reduced morbidity associated with VATS translates into an improvement in MG symptoms. Beyond debates about the surgical approach, Jaretzki and Sonett suggested that the crucial factor lies not in the approach itself but in the extent of resection, recommending excision of the cervical poles of the thymus to avoid leaving up to 25% of the gland behind.…”

Section: Discussionmentioning

confidence: 90%

Are the minimally invasive techniques the new gold standard in thymus surgery for myasthenia gravis? Experience of a reference single-site in VATS thymectomy

Trujillo Reyes,

Martinez Tellez,

Belda Sanchis

et al. 2024

Front. Neurol.

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The thymus is the primary lymphoid organ responsible for the maturation and proliferation of T lymphocytes. During the first years of our lives, the activation and inactivation of T lymphocytes occur within the thymus, facilitating the correct maturation of central immunity. Alterations in the positive and negative selection of T lymphocytes have been studied as the possible origins of autoimmune diseases, with Myasthenia Gravis (MG) being the most representative example. Structural alterations in the thymus appear to be involved in the initial autoimmune response observed in MG, leading to the consideration of thymectomy as part of the treatment for the disease. However, the role of thymectomy in MG has been a subject of controversy for many years. Several publications raised doubts about the lack of evidence justifying thymectomy’s role in MG until 2016 when a randomized study comparing thymectomy via sternotomy plus prednisone versus prednisone alone was published in the New England Journal of Medicine (NEJM). The results clearly favored the group of patients who underwent surgery, showing improvements in symptoms, reduced corticosteroid requirements, and fewer recurrences over 3 years of follow-up. In recent years, the emergence of less invasive surgical techniques has made video-assisted or robotic-assisted thoracoscopic (VATS/RATS) thymectomy more common, replacing the traditional sternotomy approach. Despite the increasing use of VATS, it has not been validated as a technique with lower morbidity compared to sternotomy in the treatment of MG. The results of the 2016 trial highlighted the benefits of thymectomy, but all the patients underwent surgery via sternotomy. Our hypothesis is that VATS thymectomy is a technique with lower morbidity, reduced postoperative pain, and shorter postoperative hospital stays than sternotomy. Additionally, VATS offers better clinical improvement in patients with MG. The primary objective of this study is to validate the VATS technique as the preferred approach for thymectomy. Furthermore, we aim to analyze the impact of VATS thymectomy on symptoms and corticosteroid dosage in patients with MG, identifying factors that may predict a better response to surgery.

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Section: Discussionmentioning

confidence: 90%

Are the minimally invasive techniques the new gold standard in thymus surgery for myasthenia gravis? Experience of a reference single-site in VATS thymectomy

Trujillo Reyes,

Martinez Tellez,

Belda Sanchis

et al. 2024

Front. Neurol.

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“…While the MGTX trial employed an invasive extended transsternal approach, the field of thymic surgery has moved on to better tolerable minimally invasive procedures over the last years [4,41 ▪ ]. Under this aspect, it has been a topic of intense research which surgical thymectomy procedure is best suited in clinical practice to achieve the goal of an optimal neurological outcome with minimal adverse effects.…”

Section: Surgical Technique and Perioperative Complicationsmentioning

confidence: 99%

Thymectomy in myasthenia gravis

Rath,

Moser,

Zimprich

2023

Current Opinion in Neurology

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Purpose of review Thymectomy has long been used in the treatment of patients with myasthenia gravis and antibodies against the acetylcholine receptor. However, its effectiveness has only been proven a few years ago in a randomized controlled trial in patients under the age of 65. Here, we review the current literature focusing on patient subgroups, potential biomarkers for outcome prediction and the choice of surgical approach. Recent findings Long-term follow-up studies after thymectomy confirmed that the benefits regarding clinical outcome parameters and a reduced need for immunosuppressive treatment persist. Nevertheless, a substantial proportion of patients in real-world cohorts do not reach complete stable remission after thymectomy indicating that the underlying autoimmune process is sustained in the periphery. Our understanding of the responsible mechanisms has improved with recent studies. Presently, outcome data after thymectomy in several patient subgroups, such as those aged over 50 years, those with juvenile onset or those with purely ocular symptoms are limited and have been the focus of recent research activities. Similarly, biomarkers guiding an appropriate patient selection for thymectomy are under investigation. A number of cohort studies demonstrated that minimal invasive surgical techniques such as extended robotic thymectomy lead to similar positive outcomes as a transsternal approach with potentially fewer short-term adverse effects. Summary Thymectomy is an effective treatment option in adult patients with early onset acetylcholine-receptor positive myasthenia gravis but uncertainty remains with regard to certain patient subgroups.

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“…Less invasive procedures, including transcervical thymectomy, video-assisted thoracoscopic surgery (VATS), and robotic VATS are associated with a faster recovery, shorter hospital stay, and better cosmetic outcomes. Minimally invasive procedures, especially robotic VATS, are therefore being increasingly used worldwide in the last decade [ 197 , 198 ]. Another study suggested that thymectomy was associated with complete remission in about 60% of MG patients with thymic hyperplasia, with better outcomes in patients below the age of 40 and disease duration of less than 12 months [ 199 ].…”

Section: Thymectomymentioning

confidence: 99%

Current Treatment of Myasthenia Gravis

Alhaidar

Abumurad

Soliven

et al. 2022

JCM

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Myasthenia gravis (MG) is the most extensively studied antibody-mediated disease in humans. Substantial progress has been made in the treatment of MG in the last century, resulting in a change of its natural course from a disease with poor prognosis with a high mortality rate in the early 20th century to a treatable condition with a large proportion of patients attaining very good disease control. This review summarizes the current treatment options for MG, including non-immunosuppressive and immunosuppressive treatments, as well as thymectomy and targeted immunomodulatory drugs.

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Perioperative Outcomes of Thymectomy in Myasthenia Gravis: A Thoracic Surgery Database Analysis

Cited by 11 publications

References 17 publications

Are the minimally invasive techniques the new gold standard in thymus surgery for myasthenia gravis? Experience of a reference single-site in VATS thymectomy

Are the minimally invasive techniques the new gold standard in thymus surgery for myasthenia gravis? Experience of a reference single-site in VATS thymectomy

Thymectomy in myasthenia gravis

Current Treatment of Myasthenia Gravis

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