BACKGROUNDThymectomy is an established treatment for myasthenia gravis (MG), and video-assisted thoracoscopic surgery (VATS) thymectomy has become an acceptable surgical procedure. This study aimed to compare the results of VATS thymectomy and open thymectomy and to identify the prognostic factors after thymectomy.

METHODSThe clinical data of 187 consecutive thymectomies performed between July 2000 and December 2009 were retrospectively reviewed; 75 open thymectomies and 112 VATS thymectomies. Clinical efficacy and variables influencing outcome were assessed by Kaplan-Meier survival curves and Cox proportional hazards regression analysis.

RESULTSThe operative blood loss in the VATS group was significantly less than that in the open group ((62.14 ± 55.43) ml vs. (137.87 ± 165.25) ml, P < 0.05). The postoperative crisis rate increased with the severity of preoperative MG and the prescription dose of anticholinesterase. Complete follow-up information of patients more than 12 months after the thymectomy was obtained on 151 cases, 89 cases from the VATS group and 62 cases from the open group, with a mean follow-up period of 59.3 months, range from 12 to 117 months. Complete stable remission (CSR) was the end point for evaluation of the treatment results. The overall five-year CSR rate was 57.5%. Two good prognostic factors were identified; preoperative prescription of anticholinesterase alone (P = 0.035) and non-thymomatous MG (P = 0.003). The five-year CSR rate of the ocular type of MG reached a high level of 67.4%.

CONCLUSIONSThymectomy can achieve good long-term CSR in MG, and VATS is an ideal alternative method. High-dose prescription of anticholinesterase and the advanced stage by Myasthenia Gravis Foundation of America (MGFA) classification have higher risks of postoperative crisis. Preoperative prescription of anticholinesterase alone and non-thymomatous MG are good prognostic factors. Thymectomy should also be considered for the ocular type of MG.

Adolescent ; Adult ; Aged ; Child ; Female ; Humans ; Male ; Middle Aged ; Myasthenia Gravis ; surgery ; Proportional Hazards Models ; Thoracic Surgery, Video-Assisted ; methods ; Thymectomy ; adverse effects ; methods ; Time Factors ; Treatment Outcome

OBJECTIVETo compare the therapeutic effects of video-assisted thoracoscopic extended thymectomy (VATET) and transsternal extended thymectomy (TET) for myasthenia gravis (MG).

METHODThis study included 21 patients undergoing VATET through the "three holes" approach on the right chest and 32 undergoing TET with sternum dissection. The thymus was excised and the anterior mediastinum adipose tissue removed in both groups.

RESULTSVATET was associated with reduced intraoperative blood loss and longer operative time without the use of postoperative analgesics; very few patients were admitted into the intensive care unit (ICU), showing significant differences from the TET group (P<0.05). No significant difference was found between the two groups in tracheal tube removal time, length of stay in ICU, closed thoracic drainage removal time, and postoperative hospital stay, total hospital stay, postoperative complications, total hospitalization costs, or the rate of remission and improvement (P>0.05).

CONCLUSIONSCompared with TET, VATET requires only a small incision without leaving metal foreign body in the body, and the patients experience less postoperative pain and rapid recovery, with similar mid- and long-term clinical outcomes.

Adolescent ; Adult ; Case-Control Studies ; Child ; Child, Preschool ; Humans ; Intraoperative Period ; Male ; Myasthenia Gravis ; surgery ; Postoperative Complications ; Thoracic Surgery, Video-Assisted ; adverse effects ; methods ; Thymectomy ; adverse effects ; methods ; Young Adult

OBJECTIVETo evaluate the effectiveness of thymectomy for myasthenia gravis (MG) and the relative risk factors for postoperative myasthenic crisis.

METHODSThe clinic data of 78 cases with MG who underwent thymectomy from June 1985 to June 2005 were analyzed retrospectively. The relative risk factors of postoperative myasthenic crisis were analyzed and the differences between new and old region of perioperative management were compared.

RESULTSThe symptom of MG was complete remission in 21 cases, significantly improved in 38 cases, improved in 11 cases and unchanged in 8 cases, respectively. The symptom duration before operation, preoperative serum level of anti-acetylcholine receptor antibody, Osserman stage and pathological type of thymoma were independent relative risk factors for postoperative myasthenic crisis. The new region of perioperative management was significant better than the old one.

CONCLUSIONSurgical treatment shows significant clinical benefits for patients with MG.

Adolescent ; Adult ; Female ; Follow-Up Studies ; Humans ; Male ; Middle Aged ; Muscle Weakness ; etiology ; prevention & control ; Myasthenia Gravis ; surgery ; Postoperative Complications ; prevention & control ; Retrospective Studies ; Thymectomy ; adverse effects ; methods ; Treatment Outcome

Aplastic anemia is a rare complication of thymoma and is extremely infrequent after thymectomy. We present a case of a 60-year-old woman with very severe aplastic anemia appearing sixteen months after thymectomy for a thymoma. She underwent thymectomy for a thymoma in April 2000. Preoperative examination revealed no hematologic abnormality. About sixteen months after the operation, she was readmitted because of pancytopenia with cough and fever. Bone marrow aspiration revealed a very severe hypoplasia in all the three cell lines with over 80% fatty tissue, and chest CT revealed no recurrence of thymoma. Her aplastic anemia had responded to cyclosporine A and granulocyte-colony stimulating factor (G-CSF).
Anemia, Aplastic/drug therapy/*etiology/*pathology ; Biopsy, Needle ; Bone Marrow/pathology ; Cyclosporine/administration & dosage ; Drug Therapy, Combination ; Female ; Follow-Up Studies ; Granulocyte Colony-Stimulating Factor/administration & dosage ; Humans ; Middle Aged ; Rare Diseases ; Risk Assessment ; Severity of Illness Index ; Thymectomy/*adverse effects/methods ; Thymoma/diagnosis/*surgery ; Treatment Outcome