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Thymectomy in myasthenia gravis

CURRENT OPINION IN NEUROLOGY (2023)

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Review Surgery

The short and long-term effects of open vs minimally invasive thymectomy in myasthenia gravis patients: a systematic review and meta-analysis

Yung Lee et al.

Summary: This systematic review and meta-analysis compared the post-operative and long-term outcomes of open thymectomy and minimally invasive surgical (MIS) thymectomy in MG patients. The results showed no significant difference between the two techniques in terms of post-operative and long-term outcomes, except for improved complete stable remission at 1 year in non-thymomatous MG patients who underwent MIS. Surgeon preference should guide the choice of surgical technique.

SURGICAL ENDOSCOPY AND OTHER INTERVENTIONAL TECHNIQUES (2023)

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Article Clinical Neurology

Analysis of length of stay and treatment emergent complications in hospitalized myasthenia gravis patients with exacerbation

Taylor Ramsaroop et al.

Summary: This study aims to identify factors that lead to lengthened hospital stay in acute exacerbations of Myasthenia Gravis (MG). Intubation and plasma exchange therapy are associated with longer hospital stays, while patients who had previous thymectomy have shorter hospital stays. Male patients have longer hospital stays compared to female patients. These findings have implications for the treatment and management of patients with acute exacerbations of MG.

BMC NEUROLOGY (2023)

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Article Cardiac & Cardiovascular Systems

Outcomes of Juvenile Myasthenia Gravis: A Comparison of Robotic Thymectomy With Medication Treatment

Zhongmin Li et al.

Summary: Robotic thymectomy appears to be more effective than medication therapy in treating juvenile myasthenia gravis, inducing remission and reducing the use of corticosteroids.

ANNALS OF THORACIC SURGERY (2022)

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Article Clinical Neurology

The association between anti-acetylcholine receptor antibody level and clinical improvement in myasthenia gravis

Florit Marcuse et al.

Summary: This study analyzed the association between serum levels of anti-acetylcholine receptor antibodies and clinical improvement in patients with myasthenia gravis (MG). The results showed a significant inverse association between the change in antibody levels and the odds of improvement. This suggests that changes in antibody levels can serve as an indicator of clinical status in MG patients and have important value for diagnosis and follow-up.

EUROPEAN JOURNAL OF NEUROLOGY (2022)

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Article Cardiac & Cardiovascular Systems

Perioperative Outcomes of Thymectomy in Myasthenia Gravis: A Thoracic Surgery Database Analysis

Shruti M. Raja et al.

Summary: This study examines the perioperative complications of open and minimally invasive thymectomy techniques in autoimmune myasthenia gravis patients. The findings suggest that minimally invasive and trans cervical thymectomies have lower odds of perioperative complications compared to transthoracic thymectomies in nonthymomatous MG cases.

ANNALS OF THORACIC SURGERY (2022)

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Article Clinical Neurology

Short-term and sustained clinical response following thymectomy in patients with myasthenia gravis

Jakob Rath et al.

Summary: This study investigated the short- and long-term outcomes of thymectomy in patients with acetylcholine receptor antibody-positive myasthenia gravis (MG). The results showed that the sustained long-term clinical response after thymectomy is lower than the initial response rates would suggest. None of the evaluated clinical factors predicted a worse outcome, supporting the current clinical practice of patient selection for thymectomy. The relative decline of AChR-Abs after surgery appears to be a promising prognostic marker.

EUROPEAN JOURNAL OF NEUROLOGY (2022)

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Article Pediatrics

Childhood-Onset Myasthenia Gravis Patients Benefited from Thymectomy in a Long-Term Follow-up Observation

Qing Zhang et al.

Summary: This study evaluated the clinical outcomes and prognostic factors of thymectomy for pediatric patients with myasthenia gravis (CMG). The results showed that thymectomy was effective in treating CMG, especially for patients in the early course of the disease.

EUROPEAN JOURNAL OF PEDIATRIC SURGERY (2022)

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Article Anesthesiology

Perioperative Management of Patients With Myasthenia Gravis Undergoing Robotic-Assisted Thymectomy-A Retrospective Analysis and Clinical Evaluation

Georg Scheriau et al.

Summary: Postoperative myasthenic crisis with respiratory failure is a potentially lethal complication after robotic-assisted thymectomy. This study evaluated the incidence of respiratory complications and the need for ICU capacities in patients with myasthenia gravis. The implementation of a standardized perioperative algorithm led to a reduction in ICU admissions.

JOURNAL OF CARDIOTHORACIC AND VASCULAR ANESTHESIA (2022)

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Article Pathology

Ectopic germinal centers in the thymus accurately predict prognosis of myasthenia gravis after thymectomy

Joona Sarkkinen et al.

Summary: This study used digital pathology to explore the predictive ability of thymic histopathology in non-thymomatous myasthenia gravis (NTMG). The results showed differences in thymic histology between early-onset MG (EOMG) and late-onset MG (LOMG), and the impact of thymic changes on thymectomy outcomes. The number of ectopic germinal centers (eGC) was found to be a valuable predictor for post-thymectomy outcomes in EOMG patients.

MODERN PATHOLOGY (2022)

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Review Clinical Neurology

Novel pathophysiological insights in autoimmune myasthenia gravis

Gianvito Masi et al.

Summary: Recent research has provided a deeper understanding of the mechanisms underlying autoimmune myasthenia gravis, particularly in different disease subtypes. Additionally, a wider spectrum of treatment options has brought more benefits to patients. Furthermore, clinical observations have revealed new MG phenotypes, but the underlying immunobiology remains unclear.

CURRENT OPINION IN NEUROLOGY (2022)

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Article Genetics & Heredity

Thymectomy in ocular myasthenia gravis-prognosis and risk factors analysis

Jinwei Zhang et al.

Summary: This study aimed to explore the clinical predictors of post-thymectomy OMG prognosis. The study found that RNS-positivity and histotype B2/B3 thymoma were independent predictors of conversion to GMG in OMG patients after thymectomy, while thymic hyperplasia and stage I thymoma predicted CSR.

ORPHANET JOURNAL OF RARE DISEASES (2022)

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Article Surgery

Efficiency of ectopic thymectomy by three surgical approaches in non-thymomatous myasthenia gravis

Shuishen Zhang et al.

Summary: The efficiency of ectopic thymectomy varies among the three surgical approaches in patients with non-thymomatous myasthenia gravis. The trans-sternum approach showed the best efficacy, while right unilateral thoracoscopy and thoracoscopic subxiphoid approaches have advantages in short-term postoperative recovery.

UPDATES IN SURGERY (2022)

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Article Surgery

Assessment of length of stay and cost of minimally invasive versus open thymectomies in patients with myasthenia gravis in Florida

Rocio Castillo-Larios et al.

Summary: This study compared the perioperative outcomes and cost between open thymectomy and minimally invasive thymectomy for myasthenia gravis. The results showed that patients who underwent minimally invasive thymectomy had a significantly shorter length of stay and a lower, although not significant, overall cost.

GLAND SURGERY (2022)

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Article Immunology

The effect of immunosuppression or thymectomy on the response to tetanus revaccination in myasthenia gravis

Ellen Strijbos et al.

Summary: This study demonstrates that tetanus toxoid (TT) revaccination does not alter the composition of lymphocyte compartments in myasthenia gravis (MG) patients with stable disease. It also effectively stimulates TT-specific proliferative responses.

JOURNAL OF NEUROIMMUNOLOGY (2022)

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Article Cardiac & Cardiovascular Systems

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

Candice L. Wilshire et al.

Summary: The study findings suggest that for patients with myasthenia gravis, a left-sided thymectomy may be preferred over a right-sided approach due to shorter operating times and potentially better medium-term symptomatic outcomes. Additionally, a lower severity class is associated with a 'good outcome'.

EUROPEAN JOURNAL OF CARDIO-THORACIC SURGERY (2021)

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Review Clinical Neurology

Effectiveness of thymectomy in juvenile myasthenia gravis and clinical characteristics associated with better outcomes

Wei Chin Ng et al.

Summary: Thymectomy may play a role in the treatment of juvenile myasthenia gravis, especially in patients with specific clinical characteristics. Advances in surgical approaches have the potential to improve treatment outcomes and reduce complications.

NEUROMUSCULAR DISORDERS (2021)

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Article Clinical Neurology

Thymectomy and Risk of Generalization in Patients with Ocular Myasthenia Gravis: A Multicenter Retrospective Cohort Study

Huanhuan Li et al.

Summary: This study found that thymectomy may effectively reduce the risk of progression from ocular myasthenia gravis to generalized myasthenia gravis in patients.

NEUROTHERAPEUTICS (2021)

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Review Immunology

Thymus and autoimmunity

Alexander Marx et al.

Summary: The thymus plays a crucial role in preventing autoimmune diseases through various mechanisms, and subtle dysfunctions in the thymus may exacerbate polygenic autoimmune diseases. Genetic mutations affecting positive selection are important factors in autoimmune diseases.

SEMINARS IN IMMUNOPATHOLOGY (2021)

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Article Clinical Neurology

Thymectomy in Juvenile Myasthenia Gravis Is Safe Regarding Long Term Immunological Effects

Trine H. Popperud et al.

Summary: This study investigated the long-term effects of thymectomy on the immune system in juvenile myasthenia gravis patients. The findings indicated premature aging of the immune system in patients who underwent thymectomy, but no increased risk of malignancies or infections were observed.

FRONTIERS IN NEUROLOGY (2021)

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Article Clinical Neurology

Single-cell profiling of myasthenia gravis identifies a pathogenic T cell signature

Florian Ingelfinger et al.

Summary: This study utilized high-dimensional single-cell mass and spectral cytometry to explore the immune dysregulation in Myasthenia gravis (MG) patients, identifying two dysregulated subsets of inflammatory T helper cells that were reduced in the blood of MG patients and inversely correlated with disease severity. These cellular markers rebounded in the blood of MG patients after thymus removal surgery, suggesting their potential role as markers of disease activity.

ACTA NEUROPATHOLOGICA (2021)

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Article Clinical Neurology

Intrathymic Plasmablasts Are Affected in Patients With Myasthenia Gravis With Active Disease

Yohei Yamamoto et al.

Summary: The study found that the frequency of circulating and intrathymic plasmablasts was significantly higher in patients with myasthenia gravis (MG), while the frequency of CD19(+)B220(high) thymic B cells was not increased in MG thymus. The expression of CXCR5 on plasmablasts in MG thymus was increased and correlated with preoperative disease activity. The frequency of intrathymic Tfh cells was significantly lower in patients who received immunosuppressive therapy.

NEUROLOGY-NEUROIMMUNOLOGY & NEUROINFLAMMATION (2021)

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Article Surgery

Minimally invasive thymectomy for myasthenia gravis: a 7-year retrospective study

Jian Gao et al.

Summary: This study compared the surgical and neurological outcomes of video-assisted thoracoscopic thymectomy with a modified subxiphoid and bilateral approach in patients with MG and thymic masses. The modified subxiphoid approach was found to be superior in surgical outcomes while yielding similar neurological outcomes, suggesting it as a recommended alternative.

GLAND SURGERY (2021)

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Article Clinical Neurology

Impact of the Surgical Approach to Thymectomy Upon Complete Stable Remission Rates in Myasthenia Gravis A Meta-analysis

Paola Solis-Pazmino et al.

Summary: In patients with MG, different surgical techniques for thymectomy showed similar rates of CSR at 3 years. The only significant difference was seen at 10 years between traditional open and minimally invasive approaches. Extended minimally invasive approaches appear to be equivalent to extended transsternal approaches in achieving CSR.

NEUROLOGY (2021)

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Article Cardiac & Cardiovascular Systems

Robotic thymectomy for thymoma in patients with myasthenia gravis: neurological and oncological outcomes

Gaetano Romano et al.

Summary: This study analysed the outcomes of 53 patients with thymoma, 34 of whom had myasthenia gravis, treated with robotic surgery. The results showed that robotic surgery was effective in improving neurological outcomes in thymoma patients with MG. Additionally, oncological outcomes confirmed the efficacy of robotic surgery in treating thymic malignancies, however longer follow-up observations are necessary due to the slow growth of thymomas.

EUROPEAN JOURNAL OF CARDIO-THORACIC SURGERY (2021)

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Article Clinical Neurology

Comorbidities worsen the prognosis of generalized myasthenia gravis post-thymectomy

Sini M. Laakso et al.

Summary: In this retrospective study of 154 generalized myasthenia gravis patients who underwent thymectomy, comorbidities were found to negatively impact prognosis. There was no significant difference observed between MG patients with autoimmune diseases and those with non-AD comorbidities in terms of prognosis.

JOURNAL OF THE NEUROLOGICAL SCIENCES (2021)

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Review Genetics & Heredity

Effects of thymectomy on late-onset non-thymomatous myasthenia gravis: systematic review and meta-analysis

Jinwei Zhang et al.

Summary: Late-onset non-thymomatous myasthenia gravis (NTMG) patients have a lower likelihood of achieving clinical stable remission after thymectomy compared to early-onset patients. Thymectomy in late-onset NTMG does not show any benefits in terms of clinical stable remission/pharmacological remission when compared to conservative treatments. Further research is needed to determine the appropriate therapeutic strategies for late-onset NTMG patients.

ORPHANET JOURNAL OF RARE DISEASES (2021)

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Article Clinical Neurology

Rate of change in acetylcholine receptor antibody levels predicts myasthenia gravis outcome

Yuta Kojima et al.

Summary: The study revealed that a high RR-AChRAb is associated with a favorable outcome at 1-year post-treatment, indicating that re-measuring AChR Ab within 100 days of therapy initiation may be useful for predicting the treatment outcome of AChR Ab-positive MG patients.

JOURNAL OF NEUROLOGY NEUROSURGERY AND PSYCHIATRY (2021)

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Review Clinical Neurology

International Consensus Guidance for Management of Myasthenia Gravis 2020 Update

Pushpa Narayanaswami et al.

Summary: This study updated the 2016 formal consensus-based guidance for the management of myasthenia gravis, with updated recommendations on thymectomy and new recommendations on the use of rituximab, eculizumab, and methotrexate. The consensus guidance developed by international MG experts based on new evidence can provide direction for clinicians caring for MG patients worldwide.

NEUROLOGY (2021)

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Article Surgery

Robotic surgery vs. open surgery for thymectomy, a retrospective case-match study

Luca Luzzi et al.

Summary: The study showed that robotic-assisted surgery had advantages in terms of postoperative pain and hospital stay when treating thymus diseases.

JOURNAL OF ROBOTIC SURGERY (2021)

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Article Clinical Neurology

Practice advisory: Thymectomy for myasthenia gravis (practice parameter update) Report of the Guideline Development, Dissemination, and Implementation Subcommittee of the American Academy of Neurology

Gary S. Gronseth et al.

NEUROLOGY (2020)

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Article Clinical Neurology

Subgroup stratification and outcome in recently diagnosed generalized myasthenia gravis

Matthias Tomschik et al.

NEUROLOGY (2020)

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Article Clinical Neurology

Minimal manifestation status and prednisone withdrawal in the MGTX trial

Ikjae Lee et al.

NEUROLOGY (2020)

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Article Multidisciplinary Sciences

Thymus-derived B cell clones persist in the circulation after thymectomy in myasthenia gravis

Ruoyi Jiang et al.

PROCEEDINGS OF THE NATIONAL ACADEMY OF SCIENCES OF THE UNITED STATES OF AMERICA (2020)

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Article Clinical Neurology

Long-term effect of thymectomy plus prednisone versus prednisone alone in patients with non-thymomatous myasthenia gravis: 2-year extension of the MGTX randomised trial

Gil I. Wolfe et al.

LANCET NEUROLOGY (2019)

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Review Immunology

Characterization of the thymus in Lrp4 myasthenia gravis: Four cases

Inga Koneczny et al.

AUTOIMMUNITY REVIEWS (2019)

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Article Clinical Neurology

Thymectomy may not be associated with clinical improvement in MuSK myasthenia gravis

Katherine M. Clifford et al.

MUSCLE & NERVE (2019)

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Review Genetics & Heredity

Thymectomy in nonthymomatous myasthenia gravis - systematic review and meta-analysis

Antonio J. M. Cataneo et al.

ORPHANET JOURNAL OF RARE DISEASES (2018)

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Review Allergy

Thymic Germinal Centers and Corticosteroids in Myasthenia Gravis: an Immunopathological Study in 1035 Cases and a Critical Review

Frederique Truffault et al.

CLINICAL REVIEWS IN ALLERGY & IMMUNOLOGY (2017)

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Article Cardiac & Cardiovascular Systems

Evidence for thymectomy in myasthenia gravis: Getting stronger?

Marc de Perrot et al.

JOURNAL OF THORACIC AND CARDIOVASCULAR SURGERY (2017)

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Article Pediatrics

The role of thymectomy in the treatment of juvenile myasthenia gravis: a systematic review

Arin L. Madenci et al.

PEDIATRIC SURGERY INTERNATIONAL (2017)

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Article Clinical Neurology

EFFICACY OF PREDNISONE FOR THE TREATMENT OF OCULAR MYASTHENIA (EPITOME): A RANDOMIZED, CONTROLLED TRIAL

Michael Benatar et al.

MUSCLE & NERVE (2016)

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Article Medicine, General & Internal

Randomized Trial of Thymectomy in Myasthenia Gravis

G. I. Wolfe et al.

NEW ENGLAND JOURNAL OF MEDICINE (2016)

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Article Genetics & Heredity

Thymectomy for non-thymomatous myasthenia gravis: a propensity score matched study

Carolina Barnett et al.

ORPHANET JOURNAL OF RARE DISEASES (2014)

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Review Clinical Neurology

Thymectomy in the management of myasthenia gravis

A Jaretzki et al.

SEMINARS IN NEUROLOGY (2004)

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