AB024. Evaluation of surgical treatment of myasthenia gravis complicated thymoma
Abstract

AB024. Evaluation of surgical treatment of myasthenia gravis complicated thymoma

Naoko Ose, Takashi Kanou, Toru Kimura, Eriko Fukui, Kenji Kimura, Yasushi Shintani

Department of General Thoracic Surgery, Osaka University Graduate School of Medicine, Osaka, Japan

Correspondence to: Naoko Ose, MD, PhD. Department of General Thoracic Surgery, Osaka University Graduate School of Medicine, 2-2(L5) Yamadaoka, Suita-shi, Osaka 565-0871, Japan. Email: naokoose@thoracic.med.osaka-u.ac.jp.

Background: Thymoma-associated myasthenia gravis (TAMG) differs from nonthymomatous myasthenia gravis (MG) in its pathogenesis, and the therapeutic effect of extended thymectomy on MG is also different. The purpose of this study is to clarify the perioperative outcome of extended thymectomy for TAMG in terms of life and MG prognosis.

Methods: One hundred and eleven TAMG patients who underwent extended thymectomy at our hospital from 1993 to 2023 were enrolled. Clinico-pathological analysis and prognosis of thymoma and the status of MG were reviewed.

Results: Forty-one males and 70 females, mean age 52.8±12.9 years, Myasthenia Gravis Foundation of America (MGFA) classification was I in 33 and IIa in 31. Preoperative myasthenia gravis activities of daily living (MG-ADL) scale was 6.7±4.9. Median preoperative antiacetylcholine receptor antibody (AchR) antibody was 30 (range, 0.3–460) nmol/L. Approaches of thymectomy were hemi-clamshell incision in 3, median sternotomy in 67, video-assisted thoracoscopic surgery (VATS) in 33, robotic-assisted thoracoscopic surgery (RATS) in 8. The most common type of thymoma was type B1 in 36, and 58 patients had stage 1 Masaoka classification, but 13 patients also had stage 4 (4a: 10, 4b: 3). Postoperative complications occurred in 27 (25.2%) patients, of which 9 (8.1%) had crisis. The median follow-up was 8.2 years, 11 patients achieved complete remission and the achievement rate of minimal manifestations (MM) or better was 37.9%. MM-5 mg was achieved in 75 patients (67.6%). Recurrence occurred in 10 patients, 7 were disseminated and 1 was local recurrence. Worsening of MG at the time of recurrence was observed in 5. Death from other disease was in 5 (1 from gastric cancer), and death from thymoma was in 3. Malignancy disease occurred during the course of the disease in 3. Tumor diameter greater than 5 cm was a significant predictor of complete remission rate in TAMG (P=0.02).

Conclusions: In TAMG, the prognosis of MG is not always good even if the tumor diameter is small, and MG may worsen at the time of thymoma recurrence, so early thymothymectomy that does not induce local recurrence or dissemination will be necessary.

Keywords: Myasthenia gravis (MG); thymoma; extended thymectomy

Acknowledgments

Funding: None.

Footnote

Conflicts of Interest: All authors have completed the ICMJE uniform disclosure form (available at https://med.amegroups.com/article/view/10.21037/med-24-ab024/coif). The authors have no conflicts of interest to declare.

Ethical Statement: The authors are accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. The study was conducted in accordance with the Declaration of Helsinki (as revised in 2013). The study was approved by the Ethical Review Board for Clinical Studies at Osaka University (No. 10026-3) and informed consent from all individual participants for this retrospective analysis was waived.

Open Access Statement: This is an Open Access article distributed in accordance with the Creative Commons Attribution-NonCommercial-NoDerivs 4.0 International License (CC BY-NC-ND 4.0), which permits the non-commercial replication and distribution of the article with the strict proviso that no changes or edits are made and the original work is properly cited (including links to both the formal publication through the relevant DOI and the license). See: https://creativecommons.org/licenses/by-nc-nd/4.0/.

doi: 10.21037/med-24-ab024
Cite this abstract as: Ose N, Kanou T, Kimura T, Fukui E, Kimura K, Shintani Y. AB024. Evaluation of surgical treatment of myasthenia gravis complicated thymoma. Mediastinum 2024;8:AB024.

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