Thymectomy in myasthenic patients with thymoma: killing two birds with one stone

BACKGROUND: Thymoma and Myasthenia Gravis share several pathogenetic aspects including the role of surgery as therapeutic option. Extended thymectomy is associated with excellent survival and good local control, especially in early stages, while its role for the neurological disease has been recently validated. The aim of this study is evaluating oncological and neurological outcomes of myasthenic patients with thymoma underwent extended thymectomy.METHODS: We retrospectively collected surgical, oncological and neurological data of all myasthenic patients with thymoma underwent extended thymectomy at our department from January 1994 to December 2016. Clinical and pathological data, neurological remission rate as well as overall survival and disease-free interval were analyzed.RESULTS: Two hundred-nineteen patients underwent extended thymectomy. The B2 histotype was the most represented thymoma (24.2%), while the most prevalent pathological Masaoka stage was IIB (37.9%). The Overall Survival and Disease-Free Survival were statistically different between early- and advanced-stage. During the surveillance, 33 patients (15.1%) developed recurrences, treated in 21 cases with iterative surgery. Regarding neurological outcomes, 75 patients (34.2%) reached a complete stable remission, 84 (38.4%) a pharmacologic remission, 51 (23.3%) had an improvement of their symptoms while in 9 (4.1%) patients Myasthenia was unchanged or worsened.CONCLUSIONS: Surgery is a cornerstone in the treatment of patients with both thymoma and Myasthenia Gravis. Extended thymectomy, as proposed by Masaoka, offers considerable oncological outcomes with an excellent survival and a low recurrence-rate of thymoma; moreover, surgery leads to remarkable neurological results.