Extended thymectomy in myasthenia gravis: a team-work of neurologist, thoracic surgeon and anaesthesist may improve the outcome

Objective: We reviewed our overall experience on 163 patients, affected by myasthenia gravis, who underwent thymectomy between 1976 and 1998. A compar ison between the oldest series of 72 patients (January 1976-December 1992), referred by various neurologists and operated on through different approac hes, and the last 91 patients (January 1993-December 1998), taking part in a strict diagnostic-therapeutical programme, was made. Methods: Anagraphic data, duration of symptoms, the surgical approach, necessity of respiratory assistance, the hospital stay, histopathological findings, preoperative an d postoperative Osserman classification, as well as medications, were globa lly analyzed and then compared in the two groups. Results: Significant diff erences in the length of hospitalization (8.7 days vs.. 4.2 days; P = 0.000 01) and in the prolonged intubation rate (18 vs. 0; P < 0.000001) were obse rved in the most recent series. Patients in the preoperative Osserman stage I and operated on in the second period had a higher complete remission rat e at the univariate analysis (P < 0.001 and P < 0.0001, respectively). At t he multivariate analysis the only parameter which affected the outcome was to be operated on in the second period (P < 0.01). Conclusions: Our experie nce confirms the role of the extended thymectomy in the treatment of myasth enia gravis. Whenever an extended thymectomy was performed through a comple te sternotomy it was a quick procedure, with short hospitalization and acce ptable cosmetic results. A careful pharmacological control of the myastenic symptoms and the presence of team-work among neurologist, thoracic surgeon and anaesthesist in the peri-operative setting reduce the incidence of com plications and might increase the efficacy of the thymectomy. (C) 2001 Else vier Science B.V. All rights reserved.