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Publication - Dr Alexandra McAleenan

    Results of robotic thymectomy performed in myasthenia gravis patients older than 60 years at onset

    Citation

    Li, F, Takahashi, R, Bauer, G, Yousef, M-S, Hotter, B, Swierzy, M, McAleenan, A, Ismail, M, Meisel, A & Rückert, J-C, 2019, ‘Results of robotic thymectomy performed in myasthenia gravis patients older than 60 years at onset’. Annals of Thoracic Surgery.

    Abstract

    Background Data are limited on the safety and efficacy of robotic thymectomy in myasthenia gravis (MG) patients older than 60 years at onset.

    Methods Patients older than 60 years at MG onset who underwent robotic thymectomy in Charite Universitaetsmedizin Berlin between 2003 and 2017 were potentially eligible for inclusion. The main outcomes were perioperative complications and clinical outcome according to the MG Foundation of America Post-Intervention Status (MGFA-PIS).

    Results Sixty-eight (25 females, 43 males) of 580 MG patients who underwent robotic thymectomy were eligible for perioperative analyses (median age at MG onset 67 years [range 61-85]). The perioperative morbidity rate was 13.2% and the only perioperative mortality was due to aortic dissection. Fifty-one patients were available for further analysis with a median follow-up time of 60 months (range 12-263). The complete stable remission (CSR) rate was 7.8%, the improvement rate was 68.6% and the overall mortality rate was 11.8%. Compared with preoperative use, the average daily dose of corticosteroids was significantly reduced at the last follow-up (17.6±23.6 VS 2.6±6.1 mg, P=0.0001) without increased use of azathioprine (35.9±61.9 VS 42.7±59 mg, P=0.427). After excluding two patients seronegative for the anti-acetylcholine receptor (AChR) antibody, 10 out of 49 seropositive patients achieved “good outcome” (including four CSR, three pharmacologic remission and three minimal manifestations 0) which was predicted by being free of concomitant disease (OR: 7.307, 95% CI (1.188-44.937), P=0.032) and MGFA classification I prethymectomy (OR: 6.696, 95% CI (1.259-35.620), P=0.026).

    Conclusion Robotic thymectomy seems to be safe and effective in MG patients older than 60 years at onset with a significant steroid-sparing effect.

    Full details in the University publications repository