BENEFITS OF EARLY THYMECTOMY IN PATIENTS WITH MYASTHENIA-GRAVIS

Objective: To report our experience of early thymectomy in patients wi th myasthenia gravis. Design: Retrospective study. Setting: University department of surgery, Greece. Subjects: 76 Patients with myasthenia gravis. Interventions: Transcervical thymectomy in all cases, addition al left thoracotomy in four cases. Main outcome measures: Mortality, m orbidity, and early (6 months) and late (mean follow-up 4.8 years) res ponse to thymectomy. Results: 20 Patients had thymomas (26%). There wa s no postoperative mortality; morbidity was 11% (n = 8). There was com plete remission in 19 (25%), improvement in 49 (65%) no change in 7 (9 %), and impairment in 1 (1%) of the patients at 6 months. Patients who had had symptoms for less than 5 years (p < 0.001), were in an earlie r stage of disease (p = 0.006), and who did not have thymomas (p = 0.0 06) responded better. 3 Patients died of invasive thymoma at 2 1/2, 3, and 5 1/2 years postoperatively and 25/76 (33%) were lost to follow-u p. Of the 51 patients available for late follow-up, 19 (37%) were in r emission, in 26 (51%) the symptoms had improved, 3 (6%) were unchanged , and 3 (6%) had died of the disease. Conclusions: Transcervical thyme ctomy should be considered in patients with early myasthenia gravis.