Background:
Refractory myasthenia gravis (MG) is frequently defined as failure to respond to adequate
immunosuppressive treatments and/or thymectomy. Re-thymectomy is a treatment option
in patients with refractory MG. This study aimed to assess the safety and efficacy
of robotic extended re-thymectomy in patients with refractory MG.
Material and method:
Robotic extended re-thymectomy was performed in six patients with MG who had undergone
a previous thymectomy (one cervicotomy, two video assisted thoracoscopic surgery [VATS]
and three sternotomy). After a median follow-up time of 108 (24 – 171) months, all
patients required immunosuppressant and five (83.3%) patients required intravenous
immune globulin and/or plasma exchange to control the symptoms before re-operation.
Clinical outcomes were assessed according to the Myasthenia Gravis Foundation of America
Post-Intervention Status (MGFA-PIS).
Result:
No perioperative morbidity and mortality as well as conversion to open was observed
in our series. The median weight of specimen was 24.5 (14 – 144)g after re-thymectomy
and residual thymic tissue was found in five (83.3%) patients. After excluding one
patient who lost to the last follow-up, three patients (60%) achieved “improved” and
two (40%) achieved “unchanged” with a median follow-up time of 61 (13 – 155) months.
Compared with preoperative use, the median daily dose of corticosteroids decreased
significantly (30 [7.5 – 60] VS 0 [0 – 5] mg, p= 0.008) without significant change in cholinesterase inhibitors use (450 [240 – 600]
VS 240 [150 – 480] mg, p= 0.172) and azathioprine use (100 [50 – 200] VS 100 [0 – 150] mg, p= 0.331).
Conclusion:
Robotic extended re-thymectomy seems to be effective in patients with refractory MG
in terms of improving symptoms and reducing corticosteroids requirement.
