Two-year outcomes after left-sided VATS extended thymectomy for nonthymomatous myasthenia gravis: a single-center retrospective cohort study.

BACKGROUND

Thymectomy is used in nonthymomatous myasthenia gravis (MG) to improve clinical status and reduce treatment burden. We evaluated 24-month outcomes after left-sided video-assisted thoracoscopic surgery (VATS) extended thymectomy.

METHODS

This retrospective cohort included patients treated at National University Hospital, Damascus, from January 2013 to January 2023, with follow-up through January 2025. Patients with thymoma or insufficient 24-month outcome ascertainment were excluded. The primary outcome was minimal manifestations or better (MM-or-better) at 24 months according to MGFA post-intervention status. Longitudinal changes were assessed using Friedman and Cochran's Q tests; baseline associations were explored using univariable analyses.

RESULTS

Of 75 patients screened, 33 were included. Mean age was 31.7 years, and 69.7% were female. MGFA post-intervention status improved over time (p<0.001). MM-or-better was achieved by 60.6% at 12 months and 81.8% at 24 months, including complete stable remission in 33.3%. Median prednisone dose declined from 20 mg/day preoperatively to 0 mg/day by 6 months; prednisone-free status increased to 81.8% at 24 months (p<0.001). Median pyridostigmine dose declined from 180 to 0 mg/day at 24 months (p<0.001). Early postoperative complications occurred in 9.1%, and later neurological events in 6.1%. Univariable logistic regression identified no significant baseline associations.

CONCLUSION

Left-sided VATS extended thymectomy was followed by neurological improvement and lower prednisone and pyridostigmine requirements. Interpretation is limited by the retrospective design, small sample, and absence of a comparison group.