Source: Annual Congress 2002 - Chest trauma, airways and miscellaneous
Disease area: Thoracic oncology

Abstract

Thymectomy is considered an effective therapeutic option for patients with MG associated with mediastinal mass. Since 1995, 14 patients with anterior mediastinal mass and MG underwent extended thymectomy (4 males and 10 females, mean age 41,5). The mean duration of MG before surgery was 22,9 months. Chest CT, spirometry and stimulative electroneuromyography was a routine preoperative diagnostic procedures. MG was graded according to a modified Osserman classification. Pathological findings were thymoma (benign – 8, malignant – 2) in 10 cases (71.4%) and thymic gland hyperplasia in 5 (28.6%). We had used different approaches for thymectomy: VATS in 9 patients, sternotomy in 2, and thoracotomy in 3. There were no operative deaths or major complications. Five patients had postoperative myasthenic crisis requiring prolonged mechanical ventilation (PMV) from 9 hours till the 5 days. All of them were operated by open approaches (thoracotomy-3, sternotomy-2) and had thymomas more then II stage by Masaoka. The VATS patients had no complications at all. Two patients (14.3%) with malignant thymomas died because of MG-crisis several months after surgery. The mean follow-up was 35 months. There was no recurrence of thymoma. Nine (64,3 %) patients have improved their clinical status (5 – avoided medications and still asymptomatic; 4 – have reduced dose of drugs and clinically improved); 2 (14.3%) have a stable course of the disease with previous doses of drugs; 1 (7.1%) deterioration required more medication. Surgical removing of thymus improves the course of MG. VATS-thymectomy is reliable method for the surgical treatment of MG and should be considered an alternative to the open approaches in selected cases.

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S. M. Nuraliev, V. G. Pischik, I. M. Kuznetsov, P. K. Yablonsky (St-Petersburg, Russia). Results of thymectomy for myasthenia gravis (MG) treatment. Eur Respir J 2002; 20: Suppl. 38, 984

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