Thymectomy for myasthenia gravis: Optimal approach

Abstract

Perhaps one of the longest unresolved issues in thoracic surgery is the role of thymectomy in the treatment of myasthenia gravis (MG). Persistent questions and issues involve not only the surgical approach to thymectomy, but even the role of thymectomy itself in the treatment of myasthenia gravis. Many of these issues remain unclear because there is no level 1 evidence, and even level 2 evidence available to compare and analyze comparable study populations is limited. Results of many studies are as well not reported using appropriate Kaplan-Meier methodology, making analysis of the results even more challenging or ineffective. Additionally, myasthenia gravis is an entity in itself with varying degrees of severity, time courses, and self-remissions. Alfred Blalock, who pioneered and helped introduce thymectomy for myasthenia gravis beginning in 1939, was even noted in a comment in 1947 to show his doubts about the usefulness of thymectomy: I thought we had an answer to the thymus in MG, but such does not appear to be the case unfortunately this prophetic statement is still relevant. © 2007 Springer-Verlag London Limited.