Thymectomy for nonthymomatous myasthenia gravis: a critical analysis

There continues to be debate concerning which thymectomy technique is the procedure of choice in the treatment of nonthymomatous myasthenia gravis (MG). The debate persists primarily because of the lack of controlled prospective studies but also because of the varying presentations and clinical courses of MG patients. Analysis has been complicated by the absence, until very recently, of accepted objective definitions of severity of the illness and response to therapy as well as variable patient selection, timing of surgery, type of surgery, and methods of analysis of results. Without resolution of these issues by properly designed prospective studies, there can be no unequivocally valid comparison of the various thymectomy techniques. In this review, attempts have been made to clarify some of the controversial issues concerning the selection of a thymectomy technique in the treatment of nonthymomatous MG and to make limited recommendations based on the best available evidence.