Thoracoscopic completion thymectomy in refractory nonthymomatous myasthenia

Background. The aim of this study was to assess the efficacy of thoracoscop ic completion thymectomy in patients with refractory nonthymomatous myasthe nia. Methods. Eight patients were operated upon after transcervical (n = 6) or t ranssternal (n = 2) thymectomy. The mean interval between operations was 12 9 months. Every patient was completely disabled despite treatment with larg e dosages of prednisone in combination with pyridostigmine (n = 5) or azath ioprine (n = 3) and with repeated plasma exchanges. Results. Gross (n = 5) or microscopic (n = 3) residual thymic tissue was fo und in all patients. There was no mortality, but morbidity included 2 patie nts with postoperative myasthenic crisis requiring reintubation and mechani cal ventilation. The mean hospital stay was 4.75 days. The mean follow-up w as 28.3 months. At the last follow-up, 6 patients had achieved symptomatic improvement as expressed by significant change in mean Osserman class (3.37 versus 2.12, p = 0.03), and prednisone dosage (43 versus 20 mg/d, p = 0.03 ). Conversely, there was no difference in dosage of pyridostigmine and azat hioprine or in number of exchange cycles. Conclusions. Our results suggest that thoracoscopic completion thymectomy m ay be beneficial for selected patients with refractory nonthymomatous myast henia. (Ann Thorac Surg 2000;70:918-23) (C) 2000 by The Society of Thoracic Surgeons.