Classic vs Extended Thymectomy in Myasthenia Graves

Background: Myasthenia gravis (MG) is a chronic autoimmune disease associated with fluctuating muscle weakness and thymic abnormalities. Thymectomy is an established therapeutic option, however the relative benefits of classic versus extended thymectomy remain a subject of debate.
Aim: This study aimed to compare the results of classic and extended thymectomy in cases with myasthenia gravis.
Methods: This prospective study has been done on 16 cases with myasthenia gravis at Menoufia University Hospital. They were separated into two groups: Group A (classic thymectomy, 7) and group B (extended thymectomy, 9). Data on operative approach, perioperative outcomes, postoperative hospital stay, and symptom progression at one, two, and three months were collected and analyzed.
Results: Surgical approaches differed between groups, with full sternotomy performed in 0% of group A and 33.3% of group B, while uniport video-assisted thoracoscopic surgery (VATS) was more common in group A (71.4%) than in group B (33.3%). The mean operative time was 102.0 ± 34.4 minutes in group A and 120.5 ± 19.7 minutes in group B (p equal to 0.258). ICU stay was 0.29 ± 0.76 days in group A versus 0.78 ± 1.39 days in group B (p equal to 0.536), and hospital stay was 12.0 ± 6.3 versus 10.3 ± 4.9 days, respectively (p=0.681). Plasmapheresis requirements were similar (2.29 ± 1.50 vs. 2.22 ± 1.79 sessions). At one month, mean symptom scores were 10.86 in group A and 9.33 in group B. At 2 months, 6.57 versus 6.11 and at three months, 6.00 versus 4.11, with no statistically significant differences. No postoperative complications were reported in either group.
Conclusion: Both classic and extended thymectomy were efficient and safe for the management of myasthenia gravis, with comparable short-term outcomes. Extended thymectomy showed a trend toward longer operative time and slightly greater symptom improvement at three months, but differences were not statistically significant. Larger multicenter researches with longer monitoring are required to determine long-term advantages.