Thymectomy

About Thymectomy

Thymectomy is the surgical removal of the thymus, a gland in the front of the chest behind the breastbone that plays a role in development of the immune system. The two main indications are tumors of the thymus, such as thymoma and thymic carcinoma, and myasthenia gravis, an autoimmune disease causing muscle weakness. A large international randomized trial published in 2016 showed that thymectomy improved clinical outcomes in patients with generalized myasthenia gravis associated with acetylcholine receptor antibodies who did not have a thymoma. The traditional approach is a median sternotomy, which gives wide exposure, particularly for larger tumors. Minimally invasive approaches include video assisted thoracoscopic surgery and robotic surgery through small incisions on one or both sides of the chest, and a transcervical approach through the neck is used at some centers. For myasthenia gravis, surgeons aim to remove the thymus along with surrounding fat that may contain thymic tissue. Patients with myasthenia require careful coordination between surgeons, neurologists and anesthesiologists.