One hundred consecutive thymectomies for myasthenia gravis

• Published in: The Annals of thoracic surgery Vol. 62; no. 1; pp. 242 - 245
• Main Authors: Detterbeck, Frank C., Scott, Walter W., Howard, James F., Egan, Thomas M., Keagy, Blair A., Starek, Peter J.K., Mill, Michael R., Wilcox, Benson R.
• Format: Journal Article
• Language: English
• Published: Netherlands Elsevier Inc 01.07.1996
• Subjects: Adult; Female; Follow-Up Studies; Humans; Length of Stay - statistics & numerical data; Male; Morbidity; Myasthenia Gravis - diagnosis; Myasthenia Gravis - epidemiology; Myasthenia Gravis - surgery; Postoperative Complications - epidemiology; Severity of Illness Index; Sternum - surgery; Thymectomy - methods; Thymectomy - statistics & numerical data; Time Factors
• ISSN: 0003-4975; 1552-6259
• DOI: 10.1016/0003-4975(96)00202-0

Between June 1977 and November 1993, 100 consecutive thymectomies for myasthenia gravis were performed at University of North Carolina Hospitals in Chapel Hill. A consistent, planned protocol involving preoperative, intraoperative, and postoperative care was followed. All thymectomies were performed through a median sternotomy with removal of all visible thymus and perithymic fat in the anterior mediastinum. There was no perioperative mortality or long-term morbidity. Mean postoperative hospital stay was 6.3 days (range, 3 to 18 days). Ninety-six percent of the patients were extubated the day of the operation, and all patients were extubated within 24 hours. Mean postoperative intensive care unit stay was 1.2 days (range, 1 to 4 days). After a mean follow-up of 65 months (range, 1 to 199 months), 78% of all patients are improved by at least one modified Osserman classification when their current status is compared with their worst preoperative disease severity. In fact, 69% of patients with mild disease preoperatively (class I, II, or III maximal severity) are in pharmacologic remission (asymptomatic without regular medication), whereas 29% of patients with severe disease (class IV or V) are in remission (p = 0.0001). Our programmatic approach to thymectomy through a sternotomy has shown minimal morbidity and mortality. It is beneficial to myasthenics at both ends of the age and severity spectrum.