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Eur J Cardiothorac Surg 2003;24:677-683
© 2003 Elsevier Science NL

Impact of minimally invasive trans-cervical thymectomy on outcome in patients with myasthenia gravis

^a Division of Thoracic Surgery, Toronto General Hospital, University Health Network, University of Toronto, Toronto, Ontario, Canada
^b Division of Neurology, Toronto General Hospital, University Health Network, University of Toronto, Toronto, Ontario, Canada
^c Department of Anesthesia, Toronto General Hospital, University Health Network, University of Toronto, Toronto, Ontario, Canada

Received 29 March 2003; received in revised form 28 July 2003; accepted 6 August 2003.

^* Corresponding author. Division of Thoracic Surgery, EN 10-224, Toronto General Hospital, 200 Elizabeth Street, Toronto, M5G 2C4 Ontario, Canada. Tel.: +1-416-340-4010; fax: +1-416-340-4556
e-mail: Shaf.Keshavjee{at}uhn.on.ca

Objective: To study the impact of minimally invasive trans-cervical thymectomy on the incidence of remission of patients with myasthenia gravis (MG) in a single institution over a 10-year period. Methods: A total of 120 consecutive patients referred for video-assisted trans-cervical thymectomy between 1991 and 2000 were included in the analysis. Complete remission was defined as no symptoms and no treatment for 6 months, and remission as minimal ocular symptoms (slight ptosis) or treatment with pyridostigmine only for 6 months. Results: There were 86 females and 34 males with a median age of 33 (range 14–79) and 36 years (range 12–68), respectively. Symptoms of MG lasted between 2 months and 17 years before thymectomy (median 10 months). Surgery was converted to a partial upper sternotomy in 23 cases (19%). The median hospital stay decreased from 2 days (range 1–8) before 1994 to 1 day (range 1–8) thereafter (p<0.0001). Postoperative complications occurred in four patients (3.3%). After a median follow-up of 48 months (range 6–117 months), 50% of the patients were in complete remission (41%) or in remission (9%). Kaplan–Meier estimates rate of complete remission were 30% after 5 years of follow-up and 91% after 10 years. Conclusions: Minimally invasive trans-cervical thymectomy can be performed with short hospital stay and low morbidity, and achieve excellent durable results at 10 years.

Key Words: Myasthenia gravis • Thymectomy • Video-assisted • Thymoma

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