Effects of thymectomy in myasthenia gravis

Factors influencing onset of remission in myasthenia gravis were evaluated in 2062 patients, of whom 962 had had thymectomy. Multivariate analysis showed that appearance of early remissions among all patients was significantly and independently influenced by thymectomy, by milder disease, and by abs...

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Bibliographic Details
Published in:Annals of surgery 1987-07, Vol.206 (1), p.79-88
Main Authors: PAPATESTAS, A. E, GENKINS, G, KORNFELD, P, EISENKRAFT, J. B, FAGERSTROM, R. P, POZNER, J, AUFSES, A. H. JR
Format: Article
Language:English
Subjects:
Biological and medical sciences
Diseases of striated muscles. Neuromuscular diseases
Evaluation Studies as Topic
Humans
Medical sciences
Myasthenia Gravis - mortality
Myasthenia Gravis - therapy
Neurology
Prognosis
Remission Induction
Thymectomy
Thymoma - complications
Thymoma - surgery
Thymus Neoplasms - complications
Thymus Neoplasms - surgery
Time Factors
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Summary:Factors influencing onset of remission in myasthenia gravis were evaluated in 2062 patients, of whom 962 had had thymectomy. Multivariate analysis showed that appearance of early remissions among all patients was significantly and independently influenced by thymectomy, by milder disease, and by absence of coexisting thymomas. Patients with mild generalized symptoms treated with thymectomy reached remission more frequently, even when compared with those with ocular myasthenia treated without surgery. Short duration of disease before thymectomy in mild cases was another factor associated with earlier remissions. Mortality for all patients was significantly and independently influenced by severity of symptoms, age, associated thymomas, and failure to remove the thymus. Patients without thymectomy and with thymomas had, in addition, earlier onset of extrathymic neoplasms. Morbidity after the transcervical approach was minimal. This study demonstrates that early thymectomy by the transcervical approach, when technically feasible, has significant clinical advantages over the transthoracic approach and should be advocated for all patients with myasthenia gravis, including those with ocular disease.
ISSN:0003-4932
1528-1140
DOI:10.1097/00000658-198707000-00013