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Choosing surgery is a big decision for many health issues. Fortunately, advances in surgical technique offer less invasive options with improved outcomes for many patients.
Myasthenia gravis patients may be offered surgical treatment to remove the thymus gland.
The American Autoimmune Related Diseases Association describes myasthenia gravis as a chronic autoimmune disease characterized by reversible fatigue. It is caused by a disturbance of neuromuscular transmission.
According to the Mayo Clinic website, approximately 15 percent of myasthenia gravis patients also have a tumor in the thymus gland. The thymus is part of the immune system, located under the breast bone (sternum).
Surgery to remove the thymus is recommended for all patients with such tumors.
Myasthenia gravis patients without thymus tumors may also benefit from removal of the thymus, but it is not so clear in these cases whether the potential benefits outweigh the risks.
Healthy thymus glands are routinely removed from infants who receive cardiothoracic surgery.
Nancy J. Halnon of the David Geffen School of Medicine at UCLA, Los Angeles, California, and colleagues reported that patients are at increased risk of skin rashes from eczema and atopic dermatitis after thymus removal. However, the total number of regulatory T cells is not reduced.
Halnon recommended further studies of immune function after removal of the thymus.
The traditional surgical technique for thymus removal is called transsternal thymectomy. A newer, less invasive technique is called video-assisted thoracoscopic surgery (VATS).
This technique requires more time in the operating room, but has other benefits. Imran Zahid of Imperial College London and colleagues performed a literature search of studies comparing the two techniques.
“Surgical management of MG [myasthenia gravis] is becoming increasingly recognised as an effective treatment option,” Zahid wrote.
Studies comparing the two surgical techniques have been performed on patients without thymus tumors, as well as on patients with these tumors. The results indicate the two techniques are equivalent in terms of postoperative mortality and complete stable remission rates.
The VATS technique was superior in terms of hospital stay, operative blood loss, and patient satisfaction. “Hence, VATS may be considered in preference to the transsternal approach despite its greater operative times,” Zahid concluded.
References:
American Autoimmune Related Diseases Association. Patient Information. Web. April 19, 2012.
http://www.aarda.org/patient_information.php
Mayo Clinic. Myasthenia gravis. Web. April 19, 2012.
http://www.mayoclinic.com/health/myasthenia-gravis/DS00375/METHOD=print
Halnon NJ et al, “Immune dysregulation after cardiothoracic surgery and incidental thymectomy: maintenance of regulatory T cells despite impaired thymopoiesis”, Clin Dev Immunol 2011; 2011: 915864. http://www.ncbi.nlm.nih.gov/pubmed/21776289
Zahid I et al, “Video-assisted thoracoscopic surgery or transsternal thymectomy in the treatment of myasthenia gravis?” Interactive CardioVascular and Thoracic Surgery 2011; 12: 40-46. http://www.ncbi.nlm.nih.gov/pubmed/20943831
Reviewed May 14, 2012
by Michele Blacksberg RN
Edited by Jody Smith
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