JTCVS open · 2025
Clinical outcomes and follow-up after thymectomy in patients with myasthenia gravis: A Colombian cohort study.
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Alvarez-Ortega Astrid Carolina, Padilla-Londoño Natalia, Posso-Nuñez Jose Alejandro, Gomez-Martinez Josué Daniel, Quiñones-Bautista Jairo Alonso, Torres-España Nicolás Felipe, Sanchez-Ortiz Álvaro Ignacio, Velasquez-Galvis Mauricio
Аннотация
OBJECTIVE: To describe 5-year clinical outcomes after thymectomy in patients with myasthenia gravis (MG).
METHODS: We retrospectively analyzed patients who underwent thymectomy for MG between 2010 and 2023. Preoperative and annual postoperative assessments (up to 5 years) used the Myasthenia Gravis Foundation of America classification. Outcomes were stratified as complete stable remission (CSR), pharmacologic remission, or minimal manifestations, with additional evaluation by patient-reported changes in symptoms. Kaplan-Meier analyses were conducted for time-to-event data.
RESULTS: Eighty-six patients were included (median age, 42 years; 60.5% female). The median duration of symptoms was 480 days (interquartile range, 28-56 days). Most patients (n = 70; 81.4%) had a low comorbidity burden. Preoperatively, 34% were Myasthenia Gravis Foundation of America class I. Acetylcholinesterase inhibitors were used in 95% of patients. Right video-assisted thoracoscopic thymectomy was the most common approach (76%), with a 2.3% intraoperative complication rate. Thymic hyperplasia was present in 87%; thymoma, in 13%. Postoperative intensive care was required in 96.5%, with myasthenic crisis the most frequent complication (8%). The median hospital length of stay was 4 days, and there was no 30-day mortality. At 1 year, 81.7% were Myasthenia Gravis Foundation of America class I. Kaplan-Meier analysis showed 50% reported symptom improvement by 360 days (95% confidence interval, 350-375 days). By 5 years, 8% achieved CSR. Although a decline in acetylcholinesterase inhibitor dosage was observed, this was not significant (P = .225).
CONCLUSIONS: Thymectomy is associated with favorable long-term symptom control in MG, with low perioperative morbidity. However, rates of complete stable remission remain low, underscoring the need for further investigation into post-thymectomy outcomes and predictors of remission.
METHODS: We retrospectively analyzed patients who underwent thymectomy for MG between 2010 and 2023. Preoperative and annual postoperative assessments (up to 5 years) used the Myasthenia Gravis Foundation of America classification. Outcomes were stratified as complete stable remission (CSR), pharmacologic remission, or minimal manifestations, with additional evaluation by patient-reported changes in symptoms. Kaplan-Meier analyses were conducted for time-to-event data.
RESULTS: Eighty-six patients were included (median age, 42 years; 60.5% female). The median duration of symptoms was 480 days (interquartile range, 28-56 days). Most patients (n = 70; 81.4%) had a low comorbidity burden. Preoperatively, 34% were Myasthenia Gravis Foundation of America class I. Acetylcholinesterase inhibitors were used in 95% of patients. Right video-assisted thoracoscopic thymectomy was the most common approach (76%), with a 2.3% intraoperative complication rate. Thymic hyperplasia was present in 87%; thymoma, in 13%. Postoperative intensive care was required in 96.5%, with myasthenic crisis the most frequent complication (8%). The median hospital length of stay was 4 days, and there was no 30-day mortality. At 1 year, 81.7% were Myasthenia Gravis Foundation of America class I. Kaplan-Meier analysis showed 50% reported symptom improvement by 360 days (95% confidence interval, 350-375 days). By 5 years, 8% achieved CSR. Although a decline in acetylcholinesterase inhibitor dosage was observed, this was not significant (P = .225).
CONCLUSIONS: Thymectomy is associated with favorable long-term symptom control in MG, with low perioperative morbidity. However, rates of complete stable remission remain low, underscoring the need for further investigation into post-thymectomy outcomes and predictors of remission.