Comparison of the postoperative first and fifth year outcomes in patients who had undergone thymectomy for Myastenia Gravis

Öz

Aim: The efficiency of thymectomy for treating patients with Myasthenia gravis is a controversial issue. Thus, this study aimed to investigate the efficiency of thymectomy in the treatment of myasthenia gravis based on long-term follow-up results.Material and Methods: The first and fifth year clinical outcomes of 27 patients who had undergone median sternotomy and extended thymectomy for myasthenia gravis between January 1995 and January 2004 were compared statistically.Results: No statistically significant differences were found between the postoperative first and fifth year clinical outcomes of the patients.Conclusions: Thymectomy is a reliable method in the treatment of myasthenia gravis with respect to its long-term outcomes. The outcomes obtained at the end of the first and fifth year of thymectomy are not different

Anahtar Kelimeler

• Myasthenia Gravis
• thymectomy
• treatment outcome

Myastenia Gravis için timektomi yapılan hastaların postoperatif birinci ve beşinci yıl sonuçlarının karşılaştırılması

Öz

Amaç: Myastenia gravis hastalarının tedavisinde timektominin etkinliği tartışmalıdır. Bu çalışmada myastenia graviste
uzun dönem takip sonuçlarına göre timektomi etkinliğinin araştırılması amaçlandı.
Gereç ve Yöntemler: Ocak 1995 ile Ocak 2004 arasında myastenia gravis nedeniyle sternotomi ve ekstended timektomi
uygulanan 27 hastanın birinci ve beşinci yıllardaki klinik sonuçları istatistiksel olarak karşılaştırıldı.
Bulgular: Hastaların postoperatif birinci ve beşinci yıllardaki klinik sonuçları arasında istatistiksel fark saptanmadı.
Sonuçlar: Uzun dönem sonuçlarının iyi olması nedeniyle timektomi myastenia gravis tedavisinde güvenilir bir yöntemdir.
Timektomi sonrası birinci ve beşinci yıllar sonunda elde edilen sonuçlar arasında farklılık yoktur.

Anahtar Kelimeler

• Myastenia Gravis
• timektomi
• tedavi sonuçları

Kaynakça

1. Hohlfeld R, Wekerle H. The thymus in myasthenia gravis. Neurol Clin 1994; 12: 331-342.
2. Blalock A, Harvey AM, Ford FR, Lilienthal J Jr. The treatment of myasthenia gravis by removal of the thymus gland. JAMA 1941; 117: 1529-33.
3. Dural K, Yıldırım E, Han S, Ozısık K. The importance of the time interval between diagnosis and operation in myasthenia gravis patients. J Cardiovasc Surg 2003; 44; 125-9.
4. Jaretzki A, Barohn RJ, Ernstoff RM et al. Myasthenia gravis: recommendations for clinical research standarts. Ann Thorac Surg 2000; 70: 327-34.
5. Werneck LC, Cunha FMB, Scola RH. Myasthenia gravis: a retrospective study comparing thymectomy to conservative treatment. Acta Neurol Scand. 2000; 101: 41-6.
6. Hase R, Sugiura H, Fukunaga A, Takahashi H. Clinical outcomes following extended thymectomy for myasthenia gravis: report of 17 cases. Ann Thorac Cardiovasc Surg. 2006; 12: 203-6.
7. Yuan HK, Huang BS, Kung SY, Kao KP. The effectiveness of thymectomy on seronegative generalized myasthenia gravis: comparing with seropositive cases. Acta Neurol Scand 2007; 115: 181-4.
8. Ozdemir N, Kara M, Dikmen E, Nadir A. Predictors of clinical outcome following extended thymectomy in myasthenia gravis. Eur J Cardiothorac Surg 2003; 23: 233-7.

9. Shrager JB, Nathan D, Brinster CJ, Yousuf O. Outcomes after 151 extended transservical thymectomies for myasthenia gravis. Ann Thorac Surg 2006; 82: 1863-9.
10. Park IK, Choi SS, Lee JG, Kim DJ, Chung KY. Complete stable remission after extended transsternal thymectomy in myasthenia gravis. Eur J Cardiothorac Surg 2006; 30: 525-8.
11. Kawaguchi N, Kuwabara S, Nemoto Y, Fukutake T. Effects of thymectomy on late-onset myasthenia gravis without thymoma. Clin Neurol Neurosurg 2007; 109: 858-61.
12. Huang CS, Hsu HS, Huang BS, Lee HC. Factors influencing the outcome of transsternal thymectomy for myasthenia gravis. Acta Neurol Scand 2005; 112: 108-14.
13. Zielinski M, Kuzdzal J, Szlubowski A. Transservical-Subxiphoid-Videothorascopic “Maximal” thymectomy-operative technique and early results. Ann Thorac Surg 2004; 78: 404-10.
14. Zielinski M, Kuzdzal J, Szlubowski A, Soja J. Comparison of late results of basic transsternal and extended transsternal tymectomies in the treatment of myasthenia gravis. Ann Thorac Surgery 2004; 78: 253-8.
15. Kattach H, Anastasiadis K, Cleuziou J, Buckley C, Shine B. Transsternal thymectomy for myasthenia gravis; surgical outcome. Ann Thorac Surg 2006; 81: 305-8.
16. Masoaka A, Yamakawa Y, Niwa H, Fukai I. Extended thymectomy for myasthenia gravis patients; a 20-year review. Ann Thorac Surg. 1996; 62: 853-9.
17. Kim HK, Park MS, Choi YS, Kim K. Neurologic outcomes of thymectomy in myasthenia gravis: comperative analysis of the effect of thymoma. J Thorac Cardiovasc Surg. 2007; 134: 601-7.
18. Pompeo E, Nofroni I, Iavicoli N. Thorascopic completion thymectomy in refractory non-thymomatous myasthenia. Ann. Thorac Surg 2000; 70: 918-23.
19. Shrager J, Deeb M, Mick R, et al. Transcervical thymectomy for myasthenia gravis achieves results comparable to thymectomy by sternotomy. Ann Thorac Surg 2002; 74: 320-7.
20. Marulli G, Rea F. Myasthenia gravis and thymectomy: many doubts and few certainties. Eur J Cardiothorac Surg. 2014. doi: 10.1093/ejcts/ezu398.
21. Yu S, Li F, Chen B, et al. Eight-year follow-up of patients with myasthenia gravis after thymectomy. Acta Neurol Scand. 2015; 131:94-101.
22. Roth T, Ackermann R, Stein R, Inderbitzi R. Thirteen years follow-up after radical transsternal thymectomy for myasthenia gravis. Do short-term results predict long-term outcome? Eur J Cardiothorac Surg. 2002; 21: 664-70.