The Pros and Cons of Thymectomy

Thymectomy is often one of the first treatments doctors consider for many people with myasthenia gravis (MG). This surgical procedure removes the thymus, a small gland located near the breastbone.¹

Removing it may lower antibodies that contribute to muscle weakness. The long-term goal of thymectomy is remission or taking fewer MG drugs.¹

Thymectomy is suggested for those with thymomas. These are tumors on the thymus. However, thymectomy may also help those without thymomas. Doctors consider certain criteria to decide whether thymectomy is an option for a person with MG.^1-2

Thymectomy relieves muscle weakness in many people with MG. Yet, any surgery comes with risks, and thymectomy does not help everyone.¹

Different types of surgery

There are different types of thymectomy. Each type has a different way of removing the thymus.¹

Transsternal thymectomy

In this procedure, an incision is made in the skin over the breastbone. The breastbone is then divided to expose the thymus.¹

Transcervical thymectomy

In this procedure, an incision is made at the lower part of the neck, just above the breastbone. The thymus is removed through the incision. The breastbone is not divided.¹

Robotic and video-assisted

Robotic thymectomy and video-assisted thorascopic thymectomy (VATS) are minimally invasive procedures that use several tiny incisions in the chest. In the robotic procedure, the surgeon uses robotic tools to remove the thymus.¹

In the VATS procedure, a camera is inserted through 1 of the incisions so the surgeon can perform the surgery with video guidance. The thymus is removed with special tools inserted through other incisions.¹

The trans-sternal approach is most common. It is also the most invasive. Your doctor may try a less invasive thymectomy but switch during surgery. This happens if doctors need a different approach to remove the thymus tissue.¹

Does it really work?

The goal of thymectomy is to lessen weakness. If it works, you may not need some of your MG drugs. Thymectomy is a long-term treatment strategy. Symptoms may not improve for years ³

Research shows that thymectomy is best in people with:^1-2,4

• Generalized MG
• Early-onset MG
• Age under 65
• Thymoma
• Acetylcholine receptor antibodies

One study followed 100 people for up to 12 years after they had thymectomy. After the procedure:⁴

• 21 percent had complete remission
• 76 percent had significant improvement of MG symptoms
• 3 percent showed no change

Responses to a thymectomy vary based on your health, how bad your MG is, and how long you have had MG. However, thymectomy raises the rate of remission two-fold compared to using drugs alone.¹

Is one type more successful?

A 2019 study shows that using VATS may provide better short-term results. Yet, many sources say that all types of thymectomy give similar long-term outcomes. Each approach removes thymus tissue. This is what lessens MG symptoms over time.^1,5

What could exclude me from the procedure?

You may not be a right for thymectomy if you have:1-2

• Ocular MG
• Antibodies against muscle-specific kinase (MuSK) or lipoprotein-related protein 4 (LRP4)
• Seronegative MG

Thymectomy used to be ill-advised for people over 65. However, a 2019 study showed that thymectomy reduced muscle weakness in 44 percent of those over 65 years old. This means thymectomy could be considered for older people with early-onset MG.⁵

What to expect after surgery

Recovery depends on what type of thymectomy you have. Those with transsternal procedures may be in the hospital for a week. You may not be able to do some activities, like driving, for up to 6 weeks.³

Robotic procedures may have a shorter recovery. You may only be in the hospital a few days and back to your normal routine quickly.³

What are the risks?

Any surgery has risks. Some common risks of thymectomy include:³

• Bleeding
• Infection and/or pain
• Trouble with anesthesia
• Lung injury
• Nerve damage to chest wall nerves (phrenic nerve palsy)

Thymectomy requires expert knowledge and a team of doctors. The surgery is performed by a thoracic surgeon. A neurologist will also work on your treatment team.