Improved outcomes with surgery vs. medical therapy in non-thymomatous myesthenia gravis: a perspective on the results of a randomized trial.

Myasthenia gravis can be a debilitating neurological disorder that affects thousands worldwide. Thymectomy has historically been considered in patients refractory to medical therapy or with concurrent thymoma. While retrospective data and propensity matched trials have favored thymectomy in order to decrease disease severity and disease associated morbidity, no randomized data existed to clearly delineate the benefit of this practice. The reviewed paper by Wolfe et al. represents the first high-level randomized prospective study investigating the role of thymectomy in patients with non-thymomatous myasthenia gravis. In a subset of antibody positive patients undergoing thymectomy within 5 years of disease onset, the study demonstrated a decrease in steroid use, hospitalization and overall disease severity compared to patients receiving best medical therapy alone. This work provides a sound evidence-based foundation to strongly consider thymectomy early in the disease process, and possibly for expanded indications. Additionally, the onus lies on surgeons to identify the most efficacious and least morbid approaches to these operations, whether they be open, minimally invasive, robotic, or otherwise.