Thymectomy in Children

Abstract

Surgical diseases of the thymus are rare in childhood. Although thymic hyperplasia, myasthenia gravis (MG), and ectopic thymic cysts/tissues are relatively more frequent among these ones, thymectomy is commonly performed during congenital cardiac surgery and for thymoma. The indication and timing for thymectomy in thymic hyperplasia and non-thymomatous MG is controversial due to their unpredictable course. Such complex cases should be evaluated by a multidisciplinary team at a tertiary center. In thymic hyperplasia and MG, as a general management policy, thymectomy is recommended when all conservative approaches fail. Excision is the first option in symptomatic ectopic thymic cysts or tissues. There are three basic access routes for thymectomy: (I) transsternal, (II) transcervical, and (III) endoscopic (thoracoscopic/robotic). Additionally, when the extent and limits of the excision procedure are considered, the surgical techniques can be further classified in three groups: (I) simple/standard thymectomy, (II) extended thymectomy, (III) radical/maximal thymectomy. Most of the thymic disorders in children are treated with simple thymectomy, which can be performed through thoracoscopic approach. Transsternal access is usually preferred for a large thymus or advanced thymomas. Available literature supports that thymectomy can make a significant contribution to relieving generalized symptoms in selected cases of thymic hyperplasia and MG. Morbidity after thymectomy in children is minimal and mortality is negligible.