Impact of the surgical approach to thymectomy upon complete stable remission rates in myasthenia gravis: a meta-analysis

Objectives: To determine whether any of the available operative techniques confer variable chances for complete stable remission (CSR) in myasthenia gravis (MG), we performed a meta-analysis of all comparative studies of surgical approaches.

Methods: Meta-analysis of all studies providing comparative data on thymectomy approaches, with CSR reported and minimum 3 years mean follow-up.

Results: 12 cohort studies and one randomized clinical trial, containing 1598 patients, met entry criteria. At 3 years, CSR from MG was similar following VATS extended vs. both basic (RR 1.00, p=1.00, 95% CI 0.39-2.58) and extended (RR 0.96, p=0.74, CI: 0.72-1.27) transsternal approaches. CSR at 3 years was also similar following extended transsternal vs. combined transcervical-subxiphoid (RR 1.08, p=0.62, CI: 0.8-1.44) approaches. VATS extended approaches remained statistically equivalent to extended transsternal approaches through 9 years of follow-up (RR 1.51, p=0.05, CI: 0.99-2.30).  The only sign...