Symptomatic Response and Quality of Life Changes after Extended VATS Thymectomy for Autoimmune Myasthenia

Background. We analyzed the results of the left-sided extended VATS thymectomy for autoimmune myasthenia (AM) in terms of symptomatic response and quality of life changes. Methods. Between 1995 and 2002, 37 patients underwent extended VATS thymectomy as a primary (Group A, N=27) or completion (Group B, N=10) procedure. Completion procedures were carried out in patients with refractory AM after previous unsuccessful transcervical or transsternal thymectomy. Results. In group A, 20 patients had generalized AM while 7 patients had ocular AM. In group B all patients had disabling symptoms refractory to maximized medical therapy that included prednisone, pyridostigmine, azathioprine and repeated plasma exchanges. At surgery, only one group A patient required conversion to median sternotomy. In group A, ectopic thymic tissue was found in 13 patients within mediastinal and/or cervical fat while in group B all patients had macroscopic or microscopic residual thymic tissue. In group A, follow-up averaged 59 months. A significant reduction in mean Osserman score occurred since 6 months onwards (P<0.04). At 60 months, remission rate was 38% whereas Quality of life domains that improved significantly at 36 months included physical function, social function, role physical and general health. In group B, at the more recent followup no patient was in remission while 6 patients had symptomatic improvement. Also, physical function, role physical and social function domains improved significantly after thymectomy. Conclusions. We conclude that in this series, left-sided extended VATS thymectomy resulted in negligible morbidity and significant symptomatic and quality of life improvements leading us to believe that it should be considered a valid alternative to the most aggressive open approaches aimed at achieving a curative thymectomy in patients with AM.