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PONM09 Thymectomy: its role in the management of myasthenia gravis
  1. J Spillane1,2,3,
  2. D M Kullmann1,2,3,
  3. C Taylor1,2,3,
  4. N P Hirsch1,2,3,
  5. R Howard1,2,3
  1. 1DCEE Kullmann Laboratory, UK
  2. 2MRC Centre for Neuromuscular Diseases, UCL, Institute of Neurology, London, UK
  3. 3Guy's and St. Thomas' NHS Trust, London, UK
  1. Correspondence to j.spillane{at}ion.ucl.ac.uk

Abstract

Background The role of thymectomy in the management of MG continues to be debated. In the absence of an adequate RCT, it is essential to review clinical experience.

Aim To perform a 10 year audit of cases of thymectomy for MG in a tertiary referral centre.

Methods Medical case notes of all patients who underwent thymectomy were retrospectively reviewed.

Results 79 patients were identified. 22 were male. Average age at thymectomy was 32.5. Indications for thymectomy included: persistence of generalised symptoms (62%), bulbar symptoms (6%), a combination of both (8%), ocular MG (9%) and thymoma (15%). Over 90% were AChR ab positive. 45% had an enlarged gland on mediastinal imaging. Average length of ICU postoperatively was 2.2 days. Immediate postthymectomy complications included pneumonia (3.7%), pneumothorax (3.7%) and wound infection (2.5%); 7.5% suffered a hypertrophic scar. There were no long-term complications. Thymic histology revealed hyperplasia (47%), thymoma (22%), atrophic changes (10%) and a normal gland (21%). 77% of patients achieved an improvement in one point or more on the MGFA scale postthymectomy during follow-up (6 months–2 years).

Conclusion Thymectomy is commonly performed for MG and is associated with a sustained improvement in the majority of our patients.

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