The Impact Of Thymectomy In Thymomatous And Nonthymomatous Myasthenia Gravis – The Experience Of A Tertiary Center

Authors

  • Sara Cunha Thoracic surgery unit, Cardiothoracic Surgery, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal https://orcid.org/0000-0002-9756-1837
  • Pedro Faustino Neurology department, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal https://orcid.org/0000-0002-5399-5414
  • André Jorge Neurology department, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal https://orcid.org/0000-0002-6209-2356
  • Luís L. Graça Thoracic surgery unit, Cardiothoracic Surgery, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
  • Luciano Almendra Neurology department, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal https://orcid.org/0000-0001-6317-2799
  • Anabela Matos Neurology department, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
  • Luís Negrão Neurology department, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
  • Rita Pancas Thoracic surgery unit, Cardiothoracic Surgery, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal https://orcid.org/0000-0002-6364-8125

DOI:

https://doi.org/10.48729/pjctvs.328

Keywords:

Myasthenia Gravis, Thymectomy, Thymoma, Nonthymomatous Myasthenia Gravis

Abstract

Introduction: Thymectomy remains a mainstay of treatment in Thymomatous (T) and Nonthymomatous (nT) Myasthenia Gravis (MG), with improved clinical outcomes and reduced need for medical treatment, however, there is little research regarding long-term follow-up. We aim to assess the impact of surgery on the long-term outcome of patients with MG at our center.
Methods: Retrospective analyses of MG patients submitted to thymectomy between 2007 and 2017 at the thoracic surgery department of CHUC. Clinical assessment was performed according to the MG Foundation of America (MGFA) Clinical Classification (cMGFA). The follow-up was categorized according to the MGFA Post-intervention Status (MGFA-PIS) and cMGFA. Statistical analysis was performed with SPSS, to a significance level of 5%.
Results: Thirty-seven patients underwent extended thymectomy and 67.6% were female. Median age at diagnosis was 46.68±19.2 years. Most patients (83.8%) had anti-acetylcholine receptor antibodies and 81.1% had generalized forms of MG. Many patients (67.6%) had surgery less than 12 months after the clinical diagnosis. TMG was present in 19 (51.4%) patients. Compared to nTMG, these patients were older (54.06±17.9 vs 40.17±19.4 years) and most were men (52.9% vs 16.7%). We obtained a good outcome in most patients in the first (81.1%), second (86.1%), and fifth (84.8%) year of follow-up. There was a shift towards better prognosis categories in the good outcome group: 9.1% CSR, 3.0% PR, and 66,7% MM in the fifth year. Preoperative medical treatment did not influence the long-term follow-up outcome. A shorter time to surgery (< 12 months) correlated with better outcomes at year 5 (p=0.016).
Conclusion: Thymectomy led to a sustained clinical improvement in our cohort, allowing for a reduced need for medication. A shorter time to surgery seems to have a positive influence on long-term prognosis. We expect that an extended follow-up would improve our results.

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Published

09-02-2024

How to Cite

1.
Cunha S, Faustino P, Jorge A, Graça LL, Almendra L, Matos A, Negrão L, Pancas R. The Impact Of Thymectomy In Thymomatous And Nonthymomatous Myasthenia Gravis – The Experience Of A Tertiary Center. Rev Port Cir Cardiotorac Vasc [Internet]. 2024 Feb. 9 [cited 2024 Feb. 28];30(4):31-8. Available from: https://pjctvs.com/index.php/journal/article/view/328

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