Video-Assisted Thoracoscopic Surgery For Myasthenia Gravis Associated With Thymoma: A 13-Year Experience (P2.090)

OBJECTIVE: To present the long-term results of video-assisted thoracoscopic surgery (VATS) used on patients with myasthenia gravis (MG). BACKGROUND: Although VATS has become a well established surgical procedure, there are few reports regarding its long-term effects on MG. MATERIAL/METHODS: Ten patients (5 males and 5 females) suffering from MG underwent VATS at the University Hospital of Heraklion since the year 2000. Their age ranged from 16 to 64 years (median 29.5 years). Prior to surgery, three patients were receiving pyridistigmine and four steroids. Two patients received I.V. immunoglobulins ten days prior to the operation. All patients underwent unilateral VATS; the left-sided approach was used in 8 patients the right-sided in 2 patients. The time from disease onset to the operation ranged from one month to 12 years (median 1,5 years). Histologic examination of the removed tissue revealed thymic hyperplasia in four patients and thymoma in six. The latter was of Masaoka stage I in four patients and stage II in two. RESULTS: All patients but, one, had an uneventful peri-operative course. One patient with Masaoka stage II thymoma developed intra-operative bleeding due to injury of the inominate vein for which a right antero-lateral thoracotomy was performed. All patients improved following surgery, with this improvement commencing 1 to 8 months after surgery. Follow-up, ranging 1 to 13 years (median 5 years), revealed that all patients with thymic hyperplasia and one with thymoma grade I achieved complete remission, which remained even after all anti-MG medications were withdrawn. Of the remaining 5 patients with thymoma, one continued her immunosuppressive treatment, while four started receiving such treatment after surgery due to lack of control over their symptoms. CONCLUSION: Our data, based on long-term follow-up, suggest that VATS can be considered a safe and effective surgery procedure for patients with MG. Disclosure: Dr. Tzagournissakis has nothing to disclose. Dr. Lasithiotakis has nothing to disclose. Dr. Andreou has nothing to disclose. Dr. Mavridis has nothing to disclose. Dr. Mastorodemos has nothing to disclose. Dr. Amoiridis has nothing to disclose. Dr. Plaitakis has nothing to disclose. Dr. Chalkiadakis has nothing to disclose.