Clinical Characteristics, Surgical Risks, and Long-Term Prognosis of Good's Syndrome

Objective Good's syndrome (GS), a rare condition characterized by thymoma with hypogammaglobulinemia, is associated with recurrent infections and poorer prognosis. Advances in minimally invasive procedures, such as video-assisted thoracoscopic surgery (VATS) and robotic-assisted thoracoscopic surgery (RATS), may help reduce perioperative complications in thymoma surgery. Given these considerations, we aimed to evaluate the surgical outcomes and long‑term prognosis of patients with GS undergoing thymectomy, with particular attention to minimally invasive approaches, such as VATS and RATS. Methods We retrospectively reviewed thymectomy cases at Hokkaido University Hospital (2007-2024). Clinical background, surgical procedures, and outcomes were compared between GS and non-GS patients. Survival was analyzed using Kaplan-Meier curves and log-rank tests. We also conducted a detailed evaluation of perioperative management and long-term outcomes in the seven patients with GS. Results Among 104 thymectomy cases, seven had GS. All GS patients had type AB thymoma, significantly more frequent than in non-GS cases. Surgical approaches included median sternotomy (n=2), VATS (n=2), and RATS (n=3). Perioperative outcomes were comparable to those of non-GS patients. However, immunodeficiency persisted, and five GS patients developed severe late postoperative infections, leading to two deaths. Additional late complications included extrathymic malignancies (n=2) and pure red cell aplasia (n=3). Despite the limited sample size, overall survival was significantly worse in GS patients (p=0.002). Conclusions Thymectomy for GS can be performed safely, including VATS and RATS. Nevertheless, long-term prognosis remains poor because of persistent immunodeficiency, leading to severe infections and secondary malignancies, highlighting the need for vigilant postoperative management.