Results of transcervical thymectomy for myasthenia gravis in 100 consecutive patients

Objective To review the results of the authors' most recent 100 consecutive cases of transcervical thymectomy for myasthenia gravis (MG) in terms of c omplications and outcome in comparison with other reported techniques. Summary Background Data Myasthenia gravis is believed to be an autoimmune d isorder characterized by increasing fatigue with exertion. The role of thym ectomy in the management of the disease remains unproven, but there is wide spread acceptance of the notion that complete thymectomy improves the cours e of the disease. Complete excision of the thymus is the goal in all cases; however, the best technique to achieve complete thymectomy remains controv ersial. The authors favor a transcervical approach through a small collar i ncision aided by a specially designed sternal retractor. Others prefer a tr anssternal, a combined transcervical and transsternal ("maximal"), or a vid eo-assisted thoracoscopic surgical approach. Methods A retrospective review of the authors' most recent 100 consecutive transcervical thymectomies for nonthymoma-associated MG was performed using medical records and telephone interviews. Patients' symptoms were graded b efore surgery and at the most recent (within the last 6 months) postoperati ve time point, using the modified Osserman classification: 0 = asymptomatic , 1 = ocular signs and symptoms, 2 = mild generalized weakness, 3 = moderat e generalized weakness, bulbar dysfunction, or both, and 4 = severe general ized weakness, respiratory dysfunction, or both. Results There were 61 female patients and 39 male patients with a mean age of 38 years (range, 14 to 84). The median hospital stay was 1 day. There we re no deaths and no Significant complications. Seventy-eight patients who h ad undergone surgery >12 months ago were available for analysis. In these p atients, with a mean follow-up time of 5 years (median 5.3; range, 12 month s to 10 years), the median preoperative Osserman grade improved from 3.0 (m ean 2.73) before surgery to 1.0 after surgery (mean 0.94). Conclusions The transcervical approach for thymectomy for the treatment of MG produces results similar to those of other surgical approaches, with the added benefits of shortened hospital stay, decreased complications, reduce d cost, and broader physician and patient acceptance of surgical treatment.