Minimally invasive thymectomy for myasthenia gravis favours left-sided approach and low severity class

Candice L. Wilshire, Sandra L. Blitz, Carson C. Fuller, Jens C. Rückert, Feng Li, Robert J. Cerfolio, Asem F. Ghanim, Mark W. Onaitis, Inderpal S. Sarkaria, Dennis A. Wigle, Vijay Joshi, Scott Reznik, Adam J. Bograd, Eric Vallières, Brian E. Louie

Research output: Contribution to journalArticlepeer-review

7 Scopus citations

Abstract

OBJECTIVES: Complete thymectomy is a key component of the optimal treatment for myasthenia gravis. Unilateral, minimally invasive approaches are increasingly utilized with debate about the optimal laterality approach. A right-sided approach has a wider field of view, while a left-sided approach accesses potentially more thymic tissue. We aimed to assess the impact of laterality on perioperative and medium-term outcomes, and to identify predictors of a 'good outcome' using standard definitions. METHODS: We performed a multicentre review of 123 patients who underwent a minimally invasive thymectomy for myasthenia gravis between January 2000 and August 2015, with at least 1-year follow-up. The Myasthenia Gravis Foundation of America standards were followed. A 'good outcome' was defined by complete stable remission/pharmacological remission/minimal manifestations 0, and a 'poor outcome' by minimal manifestations 1-3. Univariate and multivariable logistic regression analyses were performed to assess factors associated with a 'good outcome'. RESULTS: Ninety-two percent of thymectomies (113/123) were robotic-assisted. The left-sided approach had a shorter median operating time than a right-sided: 143 (interquartile range, IQR 110-196) vs 184 (IQR 133-228) min, P = 0.012. At a median of 44 (IQR 27-75) months, the left-sided approach achieved a 'good outcome' (46%, 31/68) more frequently than the right-sided (22%, 12/55); P = 0.011. Multivariable analysis identified a left-sided approach and Myasthenia Gravis Foundation of America class I/II to be associated with a 'good outcome'. CONCLUSIONS: A left-sided thymectomy may be preferred over a right-sided approach in patients with myasthenia gravis given the shorter operating times and potential for superior medium-term symptomatic outcomes. A lower severity class is also associated with a 'good outcome'.

Original languageEnglish (US)
Pages (from-to)898-905
Number of pages8
JournalEuropean Journal of Cardio-thoracic Surgery
Volume60
Issue number4
DOIs
StatePublished - Oct 1 2021

Keywords

  • Complete stable remission
  • Laterality approach
  • Myasthenia Gravis Foundation of America
  • Myasthenia gravis
  • Pharmacological remission
  • Robotic thymectomy
  • Video-assisted thoracic surgery thymectomy

ASJC Scopus subject areas

  • Surgery
  • Pulmonary and Respiratory Medicine
  • Cardiology and Cardiovascular Medicine

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