Thymectomy

Removal of the thymus gland in the younger age group (under 50 years old) is likely to produce remission (return to normal activity without medication) in 25 per cent of cases and partial remission (return to normal activity with the addition of medication) in a further 50 per cent, but 6 months or more may be required to achieve remission. Thymectomy is the first treatment of choice in women of child-bearing age since the operation may prevent the need for immunosuppressant drugs. Patients over the age of 50 respond less well to thymectomy because the gland is more atrophic in middle age. Patients who have a thymoma should have a thymectomy in order to decrease complications from the tumor. However, as thymomas tend to occur in the older age group, the myasthenic symptoms are less likely to benefit from thymectomy alone.

Thymectomy can be performed through a trans-sternal incision. This approach exposes the thymus gland well and makes total removal more certain. It is the method most favored currently and probably the safest when excising large thymomas. A supraclavicular transcervical incision can be used if there is no thymoma present, but total thymectomy may not be achieved. More recently, minimally invasive thoracoscopic thymectomies have been performed with success and with minimum complications and postoperative morbidity (Yim etal 1995). Further studies of this novel technique are required. The thymus gland can be irradiated and thymomas are relatively radiosensitive. Radiotherapy following surgery may be useful in locally invasive tumors.

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