Thymectomy

Overview

A thymectomy is a surgical procedure that involves removing the thymus gland and thymic tumors. The thymus is situated in the upper chest, in front of the heart. Surgeons may use different techniques to perform a thymectomy, depending on factors like your Body Mass Index (BMI), any prior chest surgeries or treatments, and the size of your thymus.

Thymectomy can be performed using open or minimally invasive techniques. Pain after the procedure is generally mild, and recovery is typically quick.

Reasons for undergoing the procedure

Thymectomy procedures address issues with the thymus gland, including:

• Thymoma (thymic carcinoma) 
• Benign (noncancerous) tumors
• Neuroendocrine tumors
• Myasthenia gravis

Risks

Possible problems or negative effects from a thymectomy include:

• Bleeding.
• Damage to a nearby blood vessel, nerve, or heart.
• Pneumonia.
• Pneumothorax, or lung collapse.
• Chylothorax (lymphatuc fluid between your chest wall and lungs).
• Hemothorax (blood between your chest wall and lungs).
• In rare cases, a myasthenic crisis may be brought on by the stress of surgery.

Before the surgery

A doctor will examine you physically and go over your medical history prior to a thymectomy. Moreover, they could request the following tests:

• Pulmonary function test
• Electrocardiogram (EKG)
• Cardiac stress test
• Computed Tomography (CT) scan
• Magnetic Resonance Imaging (MRI)
• Positron Emission Tomography (PET) scan

Before undergoing a thymectomy, patients should discuss with their doctor whether to cease taking any particular drugs or supplements. If your doctor instructs you to stop taking your medication, do so.

It is likely that you will have to abstain from food and liquids by midnight the night before your surgery.

Before surgery, if you have myasthenia gravis, you might require the following to avoid breathing problems:

• Plasma exchange.
• Intravenous administration of immunoglobulin.

It is imperative that individuals diagnosed with myasthenia gravis continue to take their prescribed drugs until specifically instructed otherwise by their doctor, who is typically a surgeon or an anesthesiologist.

During the procedure

A thymectomy can be carried out by healthcare providers using either open surgery or minimally invasive techniques, which may include the use of cameras and robotic arms. It’s best to consult with your doctor to determine the most suitable approach for your situation.

Transsternal approach

Steps in thymectomy surgery include:

• Perform a sternotomy, which involves partially or completely separating your breastbone, much like open heart surgery.
• Through the incision, remove the thymus and any affected surrounding tissue.
• Insert a chest tube or two for drainage.
• Use wires to close the sternum and seal the skin.

Robotic-assisted or Video-Assisted Thoracic Surgery (VATS) approach

Steps in thymectomy surgery include:

• Starting from one side, cut three ports or openings into your chest, one of which should be for a camera.
• To isolate the thymus (and tumor, if any) from the surrounding tissues, use the robot arms or long instruments.
• To fully remove the thymus, if needed, create mirrored incisions on the other side of your chest.
• All tissue is placed in a bag within the chest and then removed through one of the small incisions made during the surgery.
• Place a chest tube or two for drainage.
• To reduce postoperative discomfort, use medicines to block nerves in the chest wall.
• Remove the ports and seal the incisions.

The duration of a thymectomy is contingent upon the technique employed by the surgeon and the complexity of the clinical situation. Two to four hours could pass during a thymectomy.

After the procedure

After a thymectomy, the breathing tube will be removed in the operating room, and you’ll be transferred to a recovery room. Initially, you’ll receive oxygen, water, and pain relief. On the day of the surgery, you will usually be moved to a standard room by your doctor.

Outcome

Recovery time varies depending on whether you had open surgery or a minimally invasive procedure. Most people stay in the hospital for at least one night, but some may need a longer stay to fully recover. Post-surgery pain is common but usually decreases within two weeks.

The effectiveness of a thymectomy for myasthenia gravis is generally assessed about a year after the procedure, as most patients do not see immediate improvement. Regular follow-up appointments with your neurologist will help determine how long you should continue taking medication for myasthenia gravis. Typically, the dosage is gradually reduced over time based on the severity of your symptoms.

After a thymectomy for myasthenia gravis, most patients experience improved symptoms a year after the procedure.

• 70% will experience at least a decrease in their medication and symptoms.
• Of these, 30 to 40 percent will fully recover from their symptoms.

Thymoma prognoses differ depending on the stage:

• Stage I thymoma: Over 95% chance of a cure.
• Stage II thymoma: 75% to 80% chance of a cure, possibly requiring radiation therapy as part of your treatment.
• Stage III thymoma: 25% to 40% chance of a cure, typically involving additional radiation and chemotherapy.

There is no universally accepted right time to return to work or school after a thymectomy. Patients with myasthenia gravis may experience fatigue that delays their ability to resume normal activities. Additionally, those with jobs that involve extensive standing or lifting may need more time to recover compared to those with desk jobs.