A thymectomy is the surgical removal of the thymus gland, which has been shown to have a role in the development of myasthenia gravis.
Roughly 10 percent of patients with myasthenia gravis have a thymoma, or a tumor on the thymus gland. While most of these slow-growing tumors are benign, some may be cancerous (malignant).
The thymus gland is part of the body’s immune system, and plays its largest role early in a person’s development. Surgical removal of the thymus has no effect on the immune system for someone after they are born.
The thymus is in the front part of the chest just behind the breast bone and in front of the heart, an area known as the anterior mediastinum, with parts (lobes) extending into the neck.
Who Needs a Thymectomy
It is recommended for patients under the age of 60 years who have moderate-to-severe weakness from myasthenia gravis. It may be recommended for patients with mild weakness if it impacts breathing or swallowing, and is recommended for anyone with a thymoma.
A surgeon experienced with performing thymectomies should review your case and determine the best approach.
Benefits of Thymectomy
In patients for whom a thymectomy is recommended, the treatment goals involve reducing patient weakness, reduction in use of medications, and achieving permanent remission of the disease. Thymectomy is considered a means of helping a patient improve their condition in the long term.
There are three main surgical approaches for thymectomy, including:
Transsternal: this anterior (frontal) approach goes through the sternum, removing the thymus, and, as necessary, the fat next to the thymus. Some approaches may include the neck to ensure removal of all of the thymus
Transcervical: this anterior transverse (horizontal) approach is by means of the lower neck, and may involve the chest to remove fat adjacent to the thymus
Videoscopic (VATS): this approach uses small incisions in the chest (right side or left), and thin, flexible tubes (scopes) with fiber-optics to let the surgeon see and remove the thymus, and, as necessary, adjoining fatty tissue
The transsternal approach is the most-often used approach for removal of thymoma.
While the surgical approaches vary, the goal remains the removal of as much of the thymus as possible, for best possible outcome. Some surgeons advocate the removal of the fatty tissue adjoining the thymus, while others feel the removal of the thymus alone is sufficient.
The extended form of transsternal thymectomy, with the removal of the adjoining fatty tissue, is the most frequently used approach, while the proponents of the transcervical and VATS minimally invasive approaches believe theirs are as effective.
It is important for a patient to discuss these surgical approaches with their doctor to determine which is right for them.
Depending on the type of surgery, and on the condition of the patient, a ventilator may be required following surgery. Once the breathing tube has been removed, the patient will be asked to breathe deeply and cough repeatedly to clear the lungs of mucus.
The patient may have one or two chest tubes (small tubes in the chest attached to drainage bottles), which will be removed shortly after surgery.
Levels of pain are mild after transcervical or VATS thymectomies, whereas there is more pain with the transsternal approach, it is temporary and may be controlled through use of pain medications. Pain usually resolves in 3 to 5 days.
Length of stay in the hospital depend on the surgical approach used and the weakness of the patient. Most patients are able to be discharged in a few days to a week.
Time away from work and other activities depends on the condition of the patient, the type of surgery received, and the nature of their work. On average, limiting activities for 3 to 6 weeks is common, with longer time before more strenuous jobs and activities can be considered.