• J. Thorac. Cardiovasc. Surg. · Mar 2012

    Active ectopic thymus predicts poor outcome after thymectomy in class III myasthenia gravis.

    • Vincenzo Ambrogi and Tommaso Claudio Mineo.
    • Department of Thoracic Surgery, Multidisciplinary Myasthenia Gravis Unit, Tor Vergata University, Rome, Italy.
    • J. Thorac. Cardiovasc. Surg. 2012 Mar 1; 143 (3): 601-6.

    ObjectiveThe presence of ectopic thymic tissue has been considered one of the most significant predictors of poor outcome after thymectomy for myasthenia gravis, but the role of active ectopic tissue is unknown. The current study analyzed the importance of this factor on post-thymectomy outcome of patients with class III myasthenia gravis.MethodsWe retrospectively reviewed 106 patients with class III, anti-acetylcholine receptor antibody-positive, nonthymomatous myasthenia gravis (70 female, 36 male; mean age, 41 ± 17 years) who underwent transsternal extended thymectomy between 1980 and 2005. Quality of life was assessed from 1996 with the Short Form 36 questionnaire. Prognosticators were investigated using complete stable remission and normalized component summaries as end points.ResultsMajor morbidity rate was 5% with no perioperative mortality. Ectopic thymic tissue was detected in 51 patients (48%), 34 of whom (67%) presented germinal centers. Complete follow-up was available in 96 patients (mean 160 ± 91 months). Fifty-two patients (54%) achieved complete stable remission, and 20 patients (21%) presented clinical and pharmacologic improvement. Lack of postoperative improvement in physical and psychosocial domains was significantly correlated with active ectopic thymus. At Kaplan-Meier evaluation, duration of symptoms (>12 months) (P = .04), oropharyngeal involvement (P = .02), germinal centers (P = .03), ectopic thymus (P = .001), and active ectopic thymus (P < .0001) were negative predictors of complete stable remission. The presence of active ectopic thymus was the most significant negative predictor of complete stable remission at Cox regression (P = .03).ConclusionsExtended thymectomy yields good outcome in patients with nonthymomatous class III myasthenia gravis. The presence of active ectopic thymus was the most significant predictor of poor outcome. These patients should be rigorously followed and undergo early aggressive therapy.Copyright © 2012 The American Association for Thoracic Surgery. Published by Mosby, Inc. All rights reserved.

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