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Unilateral video-assisted thoracoscopic extended thymectomy offers long-term outcomes equivalent to that of the bilateral approach in the treatment of non-thymomatous myasthenia gravis.

OBJECTIVES
Video-assisted thoracoscopic extended thymectomy (VATET) is commonly performed bilaterally to remove all the thymic tissue in the mediastinum for the surgical treatment of myasthenia gravis. We hypothesize that the therapeutic efficacy of unilateral thoracoscopic thymectomy (right-sided) is comparable to that of bilateral VATET.


METHODS
We retrospectively reviewed 103 consecutive patients who received VATET for non-thymomatous myasthenia gravis (NTMG), with a minimum follow-up period of 36 months.


RESULTS
Bilateral VATET was performed in the first 31 patients and right-sided VATET in the following 72. No patients died perioperatively. The operating time in the right-sided VATET group was significantly shorter than that in the bilateral VATET group (169.3 ± 19.3 vs 152.6 ± 20.7 min, P<0.001). There were no significant differences between groups, in terms of blood loss, pain severity, drainage time, ICU stay, hospital stay and postoperative morbidity. The median follow-up was 5.2 years. Forty-eight patients achieved complete stable remission (CSR). The 5-year CSR rate, calculated by Life-table analysis, was 52% in the bilateral VATET group and 47% in the right-sided VATET group. These two operative methods did not differ significantly with respect to CSR by Kaplan-Meier analysis. Multivariate analysis identified shorter disease duration (<12 months) (P = 0.021, HR = 0.50) and thymic hyperplasia (P = 0.038, HR = 0.48) as independent predictors of higher CSR rates in patients who underwent thymectomy.


CONCLUSIONS
The long-term outcome of right-sided VATET in the surgical treatment of NTMG, in terms of CSR, is comparable to that of bilateral VATET.