Progress in Thymectomy for the Treatment of Non-thymomatous Myasthenia Gravis_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

JIANG Lei

Department of Thoracic Surgery，Tongji University Affiliated Shanghai Pulmonary Hospital，Shanghai 200433，P. R. China;

Corresponding author：

Keywords：

Non-thymomatous; 　Myasthenia gravis; 　Thymectomy

DOI：

10.7507/1007-4848.20130138

Video：

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Thymectomy is a major surgical procedure for patients with non-thymomatous myasthenia gravis，and can enhance their symptomatic remission rate and cure rate. There is still much controversy about appropriate surgical approach and extent of resection of thymectomy. The majority of thoracic surgeons believe that the completeness of thymectomy is closely associated with clinical symptom improvement，and perform complete resection of encapsulated thymus and surroun-ding fat tissues via mid-sternotomy. But minimally invasive thymectomies are often more acceptable by patients. On the contrary，in view of common existence of ectopic thymus tissue，some thoracic surgeons advocate a combination of cervical incision and sternotomy in order to further completely remove all thymus tissue.

Citation： JIANG Lei. Progress in Thymectomy for the Treatment of Non-thymomatous Myasthenia Gravis. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2013, 20(4): 463-466. doi: 10.7507/1007-4848.20130138 Copy

1.	Blalock A， Mason MF， Hugh JH， et al. Myasthenia gravis and tumors of the thymic region：report of a case in which the tumor was removed. Ann Surg， 1939， 110 （4）：544-561.
2.	Ambrogi V， Mineo TC. Active ectopic thymus predicts poor outcomeafter thymectomy in classⅢmyasthenia gravis. J Thorac Cardiovasc Surg， 2012， 143 （3）：601-606.
3.	Ampollini L， Del Rio P， Sianesi M， et al. Transcervical video-assistedthymectomy：preliminary results of a modified surgical approach. Langenbecks Arch Surg， 2011， 396 （2）：267-271.
4.	Masaoka A， Yamakawa Y， Niwa H， et al. Extended thymectomy for myasthenia gravis patients：a 20-year review. Ann Thorac Surg， 1996， 62 （3）：853-859.
5.	Venuta F， Rendina EA， De Giacomo T， et al. Thymectomy for myasthenia gravis：a 27-year experience. Eur J Cardiothorac Surg， 1999， 15 （5）：621-624.
6.	Khicha SG， Kaiser LR， Shrager JB. Extended transcervical thymectomyin the treatment of myasthenia gravis. Ann N Y Acad Sci， 2008， 1132：336-343.
7.	Suda T，Sugimura H， Tochii D， et al. Single-port thymectomy through an infrasternal approach. Ann Thorac Surg， 2012， 93 （1）：334-336.
8.	Rückert JC， Walter M， Müller JM. Pulmonary function after thoracoscopic thymectomy versus median sternotomy for myasthenia gravis. Ann Thorac Surg， 2000， 70 （5）：1656-1661.
9.	Meyer DM， Herbert MA， Sobhani NC， et al. Comparative clinical outcomes of thymectomy for myasthenia gravis performed by extendedtranssternal and minimally invasive approaches. Ann Thorac Surg， 2009， 87 （2）：385-390.
10.	Huang CS， Cheng CY， Hsu HS， et al. Video-assisted thoracoscopic surgery versus sternotomy in treating myasthenia gravis：comparison by a case-matched study. Surg Today， 2011， 41 （3）：338-345.
11.	Lin MW， Chang YL， Huang PM， et al. Thymectomy for non-thymo-matous myasthenia gravis：a comparison of surgical methods and analysisof prognostic factors. Eur J Cardiothorac Surg， 2010， 37 （1）：7-12.
12.	Freeman RK， Ascioti AJ， Van Woerkom JM， et al. Long-term follow-up after robotic thymectomy for nonthymomatous myasthenia gravis. Ann Thorac Surg， 2011， 92 （3）：1018-1022.
13.	Melfi F， Fanucchi O， Davini F， et al. Ten-year experience of mediastinal robotic surgery in a single referral centre. Eur J Cardiothorac Surg， 2012， 41 （4）：847-851.
14.	Rückert JC， Ismail M， Swierzy M， et al. Thoracoscopic thymectomywith the da Vinci robotic system for myasthenia gravis. Ann N Y Acad Sci， 2008， 1132：329-335.
15.	Goldstein SD， Yang SC. Assessment of robotic thymectomy usingthe Myasthenia Gravis Foundation of America Guidelines. Ann Thorac Surg， 2010， 89 （4）：1080-1085.
16.	Weksler B， Tavares J， Newhook TE， et al. Robot-assisted thymectomyis superior to transsternal thymectomy. Surg Endosc， 2012， 26 （1）：261-266.
17.	Jaretzki A 3rd， Wolff M .“Maximal” thymectomy for myasthenia gravis. Surgical anatomy and operative technique. J Thorac CardiovascSurg ， 1988 ， 96 （5）：711-716.
18.	Zielinski M， Hauer L， Hauer J， et al. Comparison of complete remi-ssion rates after 5 year follow-up of three different techniques of thymectomy for myasthenia gravis. Eur J Cardiothorac Surg， 2010， 37 （5）：1137-1143.
19.	Shiono H， Shigemura N， Okumura M. Inclusion of the transcervicalapproach in video-assisted thoracoscopic extended thymectomy （VATET） for myasthenia gravis：a prospective trial. Surg Endosc， 2008， 22 （4）：1135-1136.
20.	Shiono H， Kadota Y， Hayashi A， et al. Comparison of outcomes after extended thymectomy for myasthenia gravis：bilateral thoracoscopic approach versus sternotomy. Surg Laparosc Endosc Percutan Tech， 2009， 19 （6）：424-427.
21.	El-Bawab H， Hajjar W， Rafay M， et al. Plasmapheresis before thymectomy in myasthenia gravis：routine versus selective protocols. Eur J Cardiothorac Surg， 2009， 35 （3）：392-397.
22.	Jensen P， Bril V. A comparison of the effectiveness of intravenous immunoglobulin and plasma exchange as preoperative therapy ofmyasthenia gravis. J Clin Neuromuscul Dis， 2008， 9 （3）：352-355.
23.	Huang CS， Hsu HS， Kao KP， et al. Intravenous immunoglobulinin the preparation of thymectomy for myasthenia gravis. Acta Neurol Scand， 2003， 108 （2）：136-138.
24.	Ponseti JM， Gamez J， Azem J， et al. Post-thymectomy combined treatment of prednisone and tacrolimus versus prednisone alone for consolidation of complete stable remission in patients with myastheniagravis：a non-randomized， non-controlled study. Curr Med Res Opin， 2007， 23 （6）：1269-1278.
25.	Gronseth GS， Barohn RJ. Practice parameter：thymectomy for autoi-mmune myasthenia gravis （an evidence-based review）：report of theQuality Standards Subcommittee of the American Academy of Neur-ology. Neurology， 2000， 55 （1）：7-15.
26.	Kawaguchi N， Kuwabara S， Nemoto Y， et al. Effects of thymectomy on late-onset myasthenia gravis without thymoma. Clin Neurol Neurosurg， 2007， 109 （10）：858-861.

1. 　Blalock A， Mason MF， Hugh JH， et al. Myasthenia gravis and tumors of the thymic region：report of a case in which the tumor was removed. Ann Surg， 1939， 110 （4）：544-561.
2. 　Ambrogi V， Mineo TC. Active ectopic thymus predicts poor outcomeafter thymectomy in classⅢmyasthenia gravis. J Thorac Cardiovasc Surg， 2012， 143 （3）：601-606.
3. 　Ampollini L， Del Rio P， Sianesi M， et al. Transcervical video-assistedthymectomy：preliminary results of a modified surgical approach. Langenbecks Arch Surg， 2011， 396 （2）：267-271.
4. 　Masaoka A， Yamakawa Y， Niwa H， et al. Extended thymectomy for myasthenia gravis patients：a 20-year review. Ann Thorac Surg， 1996， 62 （3）：853-859.
5. 　Venuta F， Rendina EA， De Giacomo T， et al. Thymectomy for myasthenia gravis：a 27-year experience. Eur J Cardiothorac Surg， 1999， 15 （5）：621-624.
6. 　Khicha SG， Kaiser LR， Shrager JB. Extended transcervical thymectomyin the treatment of myasthenia gravis. Ann N Y Acad Sci， 2008， 1132：336-343.
7. 　Suda T，Sugimura H， Tochii D， et al. Single-port thymectomy through an infrasternal approach. Ann Thorac Surg， 2012， 93 （1）：334-336.
8. 　Rückert JC， Walter M， Müller JM. Pulmonary function after thoracoscopic thymectomy versus median sternotomy for myasthenia gravis. Ann Thorac Surg， 2000， 70 （5）：1656-1661.
9. 　Meyer DM， Herbert MA， Sobhani NC， et al. Comparative clinical outcomes of thymectomy for myasthenia gravis performed by extendedtranssternal and minimally invasive approaches. Ann Thorac Surg， 2009， 87 （2）：385-390.
10. 　Huang CS， Cheng CY， Hsu HS， et al. Video-assisted thoracoscopic surgery versus sternotomy in treating myasthenia gravis：comparison by a case-matched study. Surg Today， 2011， 41 （3）：338-345.
11. 　Lin MW， Chang YL， Huang PM， et al. Thymectomy for non-thymo-matous myasthenia gravis：a comparison of surgical methods and analysisof prognostic factors. Eur J Cardiothorac Surg， 2010， 37 （1）：7-12.
12. 　Freeman RK， Ascioti AJ， Van Woerkom JM， et al. Long-term follow-up after robotic thymectomy for nonthymomatous myasthenia gravis. Ann Thorac Surg， 2011， 92 （3）：1018-1022.
13. 　Melfi F， Fanucchi O， Davini F， et al. Ten-year experience of mediastinal robotic surgery in a single referral centre. Eur J Cardiothorac Surg， 2012， 41 （4）：847-851.
14. 　Rückert JC， Ismail M， Swierzy M， et al. Thoracoscopic thymectomywith the da Vinci robotic system for myasthenia gravis. Ann N Y Acad Sci， 2008， 1132：329-335.
15. 　Goldstein SD， Yang SC. Assessment of robotic thymectomy usingthe Myasthenia Gravis Foundation of America Guidelines. Ann Thorac Surg， 2010， 89 （4）：1080-1085.
16. 　Weksler B， Tavares J， Newhook TE， et al. Robot-assisted thymectomyis superior to transsternal thymectomy. Surg Endosc， 2012， 26 （1）：261-266.
17. 　Jaretzki A 3rd， Wolff M .“Maximal” thymectomy for myasthenia gravis. Surgical anatomy and operative technique. J Thorac CardiovascSurg ， 1988 ， 96 （5）：711-716.
18. 　Zielinski M， Hauer L， Hauer J， et al. Comparison of complete remi-ssion rates after 5 year follow-up of three different techniques of thymectomy for myasthenia gravis. Eur J Cardiothorac Surg， 2010， 37 （5）：1137-1143.
19. 　Shiono H， Shigemura N， Okumura M. Inclusion of the transcervicalapproach in video-assisted thoracoscopic extended thymectomy （VATET） for myasthenia gravis：a prospective trial. Surg Endosc， 2008， 22 （4）：1135-1136.
20. 　Shiono H， Kadota Y， Hayashi A， et al. Comparison of outcomes after extended thymectomy for myasthenia gravis：bilateral thoracoscopic approach versus sternotomy. Surg Laparosc Endosc Percutan Tech， 2009， 19 （6）：424-427.
21. 　El-Bawab H， Hajjar W， Rafay M， et al. Plasmapheresis before thymectomy in myasthenia gravis：routine versus selective protocols. Eur J Cardiothorac Surg， 2009， 35 （3）：392-397.
22. Jensen P， Bril V. A comparison of the effectiveness of intravenous immunoglobulin and plasma exchange as preoperative therapy ofmyasthenia gravis. J Clin Neuromuscul Dis， 2008， 9 （3）：352-355.
23. 　Huang CS， Hsu HS， Kao KP， et al. Intravenous immunoglobulinin the preparation of thymectomy for myasthenia gravis. Acta Neurol Scand， 2003， 108 （2）：136-138.
24. 　Ponseti JM， Gamez J， Azem J， et al. Post-thymectomy combined treatment of prednisone and tacrolimus versus prednisone alone for consolidation of complete stable remission in patients with myastheniagravis：a non-randomized， non-controlled study. Curr Med Res Opin， 2007， 23 （6）：1269-1278.
25. 　Gronseth GS， Barohn RJ. Practice parameter：thymectomy for autoi-mmune myasthenia gravis （an evidence-based review）：report of theQuality Standards Subcommittee of the American Academy of Neur-ology. Neurology， 2000， 55 （1）：7-15.
26. 　Kawaguchi N， Kuwabara S， Nemoto Y， et al. Effects of thymectomy on late-onset myasthenia gravis without thymoma. Clin Neurol Neurosurg， 2007， 109 （10）：858-861.

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