Outcomes of Juvenile Myasthenia Gravis: A Comparison of Robotic Thymectomy With Medication Treatment

• Published in: The Annals of thoracic surgery Vol. 113; no. 1; pp. 295 - 301
• Main Authors: Li, Zhongmin, Li, Feng, Zhang, Hongbin, Swierzy, Marc, Ismail, Mahmoud, Meisel, Andreas, Rueckert, Jens-C.
• Format: Journal Article
• Language: English
• Published: Netherlands Elsevier Inc 01.01.2022
• Subjects: Adolescent; Child; Female; Humans; Male; Myasthenia Gravis - drug therapy; Myasthenia Gravis - surgery; Retrospective Studies; Robotic Surgical Procedures; Thymectomy - methods; Treatment Outcome
• DOI: 10.1016/j.athoracsur.2020.12.045
• ISSN: 0003-4975; 1552-6259

The study aimed to compare the clinical outcomes of patients with juvenile myasthenia gravis (MG) who underwent robotic thymectomy with that of those who only received medication therapy. We retrospectively reviewed patients who visited our institution for the diagnosis or treatment of MG with an age at onset younger than 18 years. Patients who underwent thymectomy comprised the surgical group and those who received only medication therapy comprised the nonsurgical group. The clinical outcomes were assessed according to the Myasthenia Gravis Foundation of America Post-Intervention Status. Forty-seven patients (35 female, 12 male) were included as the surgical group and 20 patients (15 female, 5 male) comprised the nonsurgical group. Significant differences were observed between the surgical and nonsurgical groups in antibody against acetylcholinesterase receptor (91.5% vs 65%; P = .012), disease duration (median 16 [interquartile range, 7-25] months vs 96 [interquartile range, 42-480] months; P < .001), and corticosteroids requirement (53.2% vs 15%; P = .004) at baseline. Kaplan-Meier analysis showed a higher cumulative probability of complete stable remission in the surgical group (P = .002) compared with the nonsurgical group. Moreover, thymectomy (hazard ratio, 3.842; 95% confidence interval, 1.116-13.230; P = .033) and age at onset (hazard ratio, 0.89; 95% confidence interval, 0.80-0.99; P = .037) were still associated with the achievement of complete stable remission in the multivariable analysis. Furthermore, a significant steroid-sparing effect was observed in the surgical group but not in the nonsurgical group. Robotic thymectomy seems to be more effective than medication therapy on juvenile MG in terms of inducing remission and reducing the use of corticosteroids.