Preoperative Plasmapheresis for Elective Thymectomy in Myasthenia Patient: Is It Necessary?

Abstract

Background. Role of plasmapheresis before thymectomy remains controversial. The aim of this study is to determine the peri-operative and post-operative outcome of a thymectomy between performing and not performing a pre-operative plasmaphreresis. Patients and Methods. A retrospective chart review study was conducted in Chiang Mai University Hospital between January 2006 and December 2011. There were 86 myasthenia patients divided into two groups; Preoperative plasmapheresis group (PPG) and no preoperative plasmapheresis group (NPPG). The primary outcome involved post-operative extubation and the secondary outcome included post-operative complications, 28 day mortality and length of hospital stay. Results. Eighty-six patients were enrolled in this study. The number of patients who had a history of myasthenic crisis at any time or within one month in the PPG was significantly more than those in the NPPG. Muscle power and forced expiratory vital capacity in the NPPG was higher than that in the PPG. The postoperative extubation rate was similar in both groups. After controlling for the propensity score, there were no statistically significant differences in both of primary and secondary outcomes. Conclusion. The results of this study shows no significant differences between both groups in all outcomes, therefore the pre-operative plasmaphresis is not necessary for elective thymectomy.

Therapeutic Plasma Exchange in Myasthenia Gravis: A Systematic Literature Review and Meta-Analysis of Comparative Evidence

“…No deaths were reported under either protocol during hospitalization ( 64 ). A third retrospective study, comparing patients receiving ( N = 33) or not receiving ( N = 53) pre-thymectomy TPE, reported 1 death during hospitalization in each group and no statistically significant difference between the two options ( p = 1.00) ( 56 ).…”

“…Retrospective studies comparing TPE to no pre-thymectomy treatment have found that TPE significantly increases speed of post-operative recovery (55,57), improves long-term response rate and magnitude (10, 55) and decreases incidence of crisis during follow up (10,55). The single exception to this trend was a retrospective study in which a lower immediate extubation rate and longer hospitalization time were reported for TPE, though in neither case were the differences statistically significant (56).…”

Iranian Consensus Recommendations for Treatment of Myasthenia Gravis

“…127 The other has evaluated PLEX versus no additional treatment in stable patients. 128 None showed a significant change between the two groups. There is no international or regional consensus for perioperative management of MG patients to date.…”

Case Series: Clinical Impact of Plasmapheresis and Thymectomy on Early-Onset Myasthenia Gravis

“…These results are largely different from the results of previous studies. Saeteng et al [ 13 ] reported that the average duration of surgery was 1.68 h, the duration of postoperative intubation was 29 h, the duration of treatment in the ICU was 55.2 h, and the duration of hospitalization was 6 days. In contrast, El-Bawab et al [ 6 ] reported that the average durations of intubation, ICU care, and length of stay were 5.3 and 45.6 h, and 9.2 days, respectively.…”

“…This result is higher than the results of previous studies. Saeteng et al [ 13 ] reported a post-thymectomy complication rate of 3.5% (3 out of 86), with 1 case each of infection, bleeding, and myasthenic crisis occurring. The reported complication rate for Mozaffar et al [ 7 ] was 24% (11 of 46), with details of 4 patients experiencing atelectasis, 5 patients with myasthenic crisis, 1 patient with respiratory distress, and 1 patient with urinary tract infection.…”