[Thymectomy for autoimmune myasthenia gravis]

Thymectomy has been performed as surgical treatment for autoimmune myasthenia gravis (MG) since the mid-1900s. Although it has been performed for more than half a century, there has been no report objectively confirming the validity of this treatment. Many groups have reported that surgery is effective in treating patients with MG, but the indications and type of surgery differ in each case. In addition, there has been no comparative trial of the results of surgery and natural progression of the disease. To resolve this situation, it would be desirable to standardize the indications for surgery in MG patients and to establish the surgical approach, as is being attempted by the Myasthenia Gravis Foundation of America although the results have not yet been announced. With recent advances in video-assisted surgery, the number of institutions in which thoracoscopic surgery is performed has increased. However, it appears that improvement in MG symptoms is dependent on the extent of resection in thymectomy. With the cervical or thorascopic approach, the extent of resection appears to be less than that using the transsternal or cervical plus transsternal approach. Before establishing a standard surgical approach, the validity of thymectomy for the treatment of MG should be confirmed in a randomized, controlled trial.