Clinical outcomes and follow-up after thymectomy in patients with myasthenia gravis: A Colombian cohort study.

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.