Robotic-assisted Thymus Surgery Outcomes Are Better Without Immunosuppressants, Study Finds

Using robotic-assisted surgery to remove the thymus without putting a patient on an  immunosuppressant afterwards leads to higher myasthenia gravis (MG) improvement and remission rates, a study suggests.

The study, “Independent long-term result of robotic thymectomy for myasthenia gravis, a single center experience” was published in the Journal of Thoracic Disease.

A robotic-assisted thymectomy is a minimally invasive surgery to remove the thymus, the gland whose functions are altered in myasthenia gravis. The removal can decrease the disease’s severity or in some cases cure it.

Researchers looked at medical records of myasthenia gravis patients who had a robotic-assisted thymectomy. They compared the outcomes of those who did not have immunosuppressive therapy after the operation with those who did.

They analyzed 37 patients with a median follow-up of 5.8 years. Of these, 32.4% (12 patients) had no immunosuppressive therapy, while 67.6% (25 patients) did.

Overall, 40.6% of the patients achieved five-year remission, and the disease of 81.6% improved.

Patients below 40 years old had significantly higher five-year remission rates and a tendency toward more disease improvement than older patients.

Patients who had no immunosuppressive therapy had significantly higher remission and improvement rates than those who had the therapy.

“After a mean follow-up of 70.0 months, we found that a significant[ly] higher 5-year CSR [complete stable remission] rate (63.5%) and improvement rate (90.3%) were shown for patients without IM [immunosuppressive therapy] usage compared to patients with IM usage,” the researchers wrote.

These results suggested that a robotic-assisted thymectomy alone is more effective at achieving remission in the long run for many mystenia gravis patients.

“A temperate delayed IM [immunosuppressive] therapy for robotic thymectomized MG [myasthenia gravis] patients was feasible with satisfactory results, and could contribute to minimize the inevitable side effects of [an] immunosuppressant,” they added.

The team found no significant differences in remission rate according to gender, disease symptoms and duration.

Overall, “the mono-therapy of robotic thymectomy” can lead to a satisfactory long-term result for some myasthenia gravis patients,” the researchers wrote. “Precision selection and individualized therapy are of the most importance.”