Thymectomy for non-thymomatous myasthenia gravis: Short and long term outcomes, a single-center 10 years' experience

Background: Myasthenia gravis (MG) is an auto-immune disorder characterized by the production of abnormal antibodies to the acetylcholine receptors at the neuromuscular junction. Radical thymectomy in many forms of MG may lead to clinical improvement in 70-80% of cases. Our objectives were to demonstrate our short and long-term results of radical trans-sternal thymectomy. Patients and methods: Retrospective analysis of prospectively collected data from 48 consecutive patients with non-thymomatous MG, managed over 10 years. All patients with thymomatous MG were excluded. The myasthenia gravis activities of daily living (MG-ADL) scoring performed for all patients and the stage of disease determined by the Myasthenia Gravis Foundation of America (MGFA) classification. The primary endpoint of this study was to evaluate early first 30 days postoperative outcomes and the secondary endpoint was to determine complete stable remission, time of pharmacological remission, and decreasing MG-ADL scoring over 5 years follow-up. Results: Totally, 48 patients included: 41 females (85.4%) and 7 males (14.5%). Generalized muscle weakness, shortness of breath, and easy fatigability were the most common presenting features. During 5 years follow up, 38 patients (79.1%) had decreased their medication dose. Time of pharmacological remission started (6-60) months. Complete stable remission (CSR) achieved in 44 patients (91.6%) over 60 months. Post-operative MG-ADL levels ranged between (12-24) scores, at the end of the follow-up period decrease to less than 10 scores. Conclusion: Radical trans-sternal thymectomy for non-thymomatous MG is an effective and well tolerated procedure that is associated with significant clinical improvement in the majority of patients. (C) 2021 The Authors. Published by Elsevier Ltd on behalf of Surgical Associates Ltd.