Thymus surgery

If the thymus is affected by a tumour, the thymus gland must be surgically removed. A specific indication for thymus removal is myasthenia gravis disease. The thymus is involved in the formation of antibodies in patients with this disease, which in turn causes muscle weakness. Nowadays, thymus surgery is often carried out using the minimally invasive thoracoscopic method.

The thymus is one of the organs of the immune system and is important for the development of immune cells in childhood, in particular. It lies behind the breastbone in the mediastinum of the chest, in the immediate vicinity of the heart. When a person reaches adulthood, the thymus reduces in size and consists primarily of fat cells. Then it has no actual function any longer. Tumours can also form in the thymus. The majority are benign and are called thymomas. The malignant variety, thymus cancer, only affects approx. 15% of thymus tumours.  However, benign tumours can also develop into cancerous tumours over time. This means that patients with thymus tumours must always have them surgically removed (thymectomy).

Myasthenia gravis is a serious muscle disease which is associated with the thymus. The disease is triggered by antibodies which form in the thymus, in particular. Therefore, a thymectomy is often carried out on patients with myasthenia gravis.

What preparations are carried out before the procedure?

Computer tomography (CT) or an MRI are carried out on patients with tumours of the thymus. to determine the position, the size and the growth behaviour of the tumour.  Additional blood examinations and muscle examinations are carried out if the patient has myasthenia gravis.

As is standard before all operations, all blood-thinning medication must be discontinued before the surgery. The operation is performed under general anaesthetic. Patients should therefore have an empty stomach for the procedure.

How is the operation performed?

The previously used open operation, which involves splitting the breastbone (sternotomy), is rarely used nowadays. The thymus is usually removed using the minimal invasive thoracoscopic procedure. In the process, a camera and instruments are inserted between the ribs into the chest. In some centres of excellence, an operation robot, the da Vinci robot, is used for this operation.

The thymus is carefully detached and removed using the camera as a guide. In the process, the surrounding tissue in the mediastinum is also inspected at the same time, and any suspicious changes are also removed. If the thoracoscopy reveals that the tumour has grown too far into the surrounding tissue, it will sometimes be necessary to switch to an open operation.

Finally, a drainage tube is inserted and the operation wounds are closed with a suture. The operation usually takes two or three hours.

What is the success rate of this procedure?

If the tumour is benign, the success rate after thymus removal are very high. During cancer, the recovery rate is dependent on the spread and the stage of the cancer.

Thymus surgery on patients with myasthenia gravis improves the symptoms in those affected in around 80% of cases.

What are the possible complications and risks of this procedure?

Thoracoscopic thymus removal is a low-risk procedure. As with all surgery, the operation may occasionally lead to infections, nerve damage, post-operative haemorrhaging or blood clots.

What happens after the operation?

After the operation, the patient's cardiovascular and respiratory function must be monitored in the intensive care ward for several hours. The drainage tube can usually already removed one or two days later. Patients who undergo this surgery must generally stay in hospital for three to four days. After an open operation with sterniotomy, the healing process takes somewhat longer. People who have undergone this surgery should avoid major physical exertion in the first two to three weeks.

If the tumour was malignant, this will be followed by radiotherapy or chemotherapy , depending on the type and stage of the disease.

If the patient has myasthenia gravis, medical treatment will be continued and regular check-ups will be required.

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