Robotic thymectomy for myasthenia gravis with or without thymoma-surgical and neurological outcomes

Context (Background): We report our experience with robotic thymectomy in patients with myasthenia gravis (MG)and provide data on the surgical results and neurologic outcomes, as per the Myasthenia Gravis Foundation of America (MGFA) recommendations for MG clinical research standards.

The study aims at reporting the surgical and neurological outcomes of patients of Myasthenia gravis treated by robotic thymectomy.

Prospective data was collected from 71 patients with myasthenia gravis (in the age range 15-67 years) with or without thymoma, who had completed a minimum follow up of one year. All patients were treated with robotic radical thymectomy. The clinical classification, status of preoperative and postoperative therapy, evaluation of post-interventional clinical status, and descriptions of morbidity/mortality were done as per the MGFA recommendations. Univariate and multivariate analysis was done to assess the factors associated with achievement of complete stable remission(CSR).

A total of 71 patients were included in this study. Twenty-one out of 71 patients (29.6%) with myasthenia gravis had thymoma. At the last follow up, 70 patients were alive. No evidence of tumour recurrence was found in patients with thymoma. The overall CSR rate was 38% with the median time to CSR of 17.5 months (range 11-48 months). The CSR rate for patient of MG with thymoma was 19 % (n=4/21). Factor found to be significantly predicting CSR were young age, lesser severity of MG and non-thymomatous histology.

Robotic thymectomy is a technically feasible and safe operation with a low morbidity and short hospitalization. It is associated with good neurological long-term results in terms of both CSR and clinical improvement.