Thymectomy

What is a thymectomy?

A thymectomy is a surgery to take out your thymus gland and thymic tumors. It’s in your upper chest in front of your heart. Surgeons can use several different approaches for thymectomy. Factors involved in the choice of method include your body mass index (BMI), prior surgery or disease treatment involving your chest, and the size of your thymus.

Thymectomies are rare procedures. One study reported that surgeons performed 7,000 thymectomy procedures in the United States during a 13-year period. Surgeons currently perform about 1,000 thymectomies per year in the U.S.

What does a thymectomy treat/manage?

A thymectomy treats problems with your thymus gland, such as:

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

How should I prepare for a thymectomy?

Before a thymectomy, a provider will review your medical history and do a physical exam. They may also order the following tests:

• Pulmonary function test.
• Electrocardiogram (EKG).
• Cardiac stress test.
• Computed tomography (CT) scan.
• Magnetic resonance imaging (MRI).
• Positron emission tomography (PET) scan.

What should I expect before my thymectomy?

Anyone having a thymectomy should talk with their provider about whether to stop taking certain medications or supplements before surgery. Only stop taking medicine if your provider tells you to.

You’ll most likely need to stop eating and drinking at midnight before your operation.

If you have myasthenia gravis, you may need the following before surgery to prevent breathing issues:

• Immunoglobulin through an IV (into your vein).
• Plasma exchange.

It’s very important that people with myasthenia gravis do not stop taking their regular myasthenia gravis medications unless their physician (generally an anesthesiologist or surgeon) explicitly tells them to do so.

What happens during a thymectomy?

Healthcare providers can perform a thymectomy using open or minimally invasive ways that use cameras and/or robotic arms. Talk with your provider about which approach is best for you.

Transsternal approach

Thymectomy surgery steps include:

1. Do a sternotomy (dividing your breastbone all or part of the way down like open heart surgery).
2. Remove the thymus and affected nearby tissue through the incision.
3. Put in one or two chest tubes for drainage.
4. Close the sternum with wires and close the skin.

Robotic-assisted or VATS (video-assisted thoracic surgery) approach

Thymectomy surgery steps include:

1. Place three ports or openings (including one for a camera) into your chest from one side.
2. Use the robot arms or long instruments to separate the thymus (and tumor if present) from the surrounding structures.
3. If necessary, make mirrored incisions on the opposite side of your chest to complete removing the thymus.
4. Place all tissue in a bag in the chest and extract it through one of the small incisions made during the surgery.
5. Place one or two chest tubes for drainage.
6. Use medication to block nerves in the chest wall to help with postoperative pain.
7. Remove the ports and close the incisions.

How long does a thymectomy take?

The length of time for a thymectomy varies depending on which method the surgeon uses and the difficulty of the clinical scenario. A thymectomy could take two to four hours.

What happens after a thymectomy?

After a thymectomy, you’ll be in a recovery room after a provider takes out the breathing tube in the operating room. You’ll need oxygen, fluids and pain medicines initially. Usually, a provider will transfer you to a regular room that same day of surgery.

What are the benefits of a thymectomy?

People with myasthenia gravis who have a thymectomy have:

• Fewer hospital stays due to their myasthenia gravis.
• Less need for prednisone and other treatments for myasthenia gravis.
• Less weakness.
• Possible remission of myasthenia gravis (feeling no weakness and needing no medication).

If you had a thymoma, thymectomy can often cure this usually slow-growing cancer.

What are the benefits of a minimally invasive thymectomy?

Compared to open procedures, minimally invasive approaches can give you:

• A shorter stay in the hospital.
• Less blood loss.
• Fewer complications.
• Less pain.
• A faster return to normal activity.

How successful is a thymectomy?

The majority of people who have a thymectomy for myasthenia gravis see benefits within a year of their operation.

• 70% will have at least a reduction in symptoms and medication.
• 30% to 40% will have complete resolution of their symptoms.

What are the risks or complications of a thymectomy?

Thymectomy side effects or complications may include:

• Injury to your heart, a nerve or a nearby blood vessel.
• Bleeding.
• Pneumothorax (collapsed lung).
• Pneumonia.
• Hemothorax (blood between your lungs and chest wall).
• Chylothorax (lymphatic fluid between your lung and chest wall).
• Very rarely, the stress of surgery can cause a myasthenic crisis.

What is the recovery time?

Recovery time varies depending on whether you had open or minimally invasive surgery. Most people stay at least one night at the hospital. Depending on your particular situation, you might need a little more time to heal in the hospital after surgery. Although it’s very treatable, pain from your surgery should go away in two weeks.

Outlook

One year after surgery, a provider will determine the benefit of thymectomy for myasthenia gravis. Most people don’t see an immediate benefit.

Follow-up appointments with your neurologist will help them decide how long to continue your medications for myasthenia gravis. Generally, they do this by lowering doses slowly over time based on your degree of symptoms.

The prognosis for thymoma varies by stage:

• Stage I thymoma: Greater than 95% chance of a cure.
• Stage II thymoma: 75% to 80% chance of a cure. You may need to include radiation therapy in your treatment.
• Stage III thymomas: 25% to 40% chance of a cure with additional radiation and chemotherapy.

When can I go back to work/school?

The right time to go back to work or school is different for everyone. People who have myasthenia gravis may have fatigue that keeps them from going back to regular activities right away. Also, people who do a lot of standing or lifting in their jobs will need more time to recover than someone with a desk job.

When should I call my healthcare provider?

After a thymectomy, contact your healthcare provider if you have:

• Shortness of breath.
• Pain on one side of your chest.
• Fast breathing.
• Fast heart rate.
• Fever.
• Cough.
• Bleeding from a healing incision.
• Worsening myasthenia gravis symptoms.

A note from Cleveland Clinic

Most people don’t have surgery often, but it’s good to remember that surgeons perform surgery every day. They want the best results for you, so don’t be afraid to ask questions about your procedure. Because surgeons can choose from several different approaches to a thymectomy, you can get peace of mind from understanding why they recommend one over another for you. Whether a thymectomy is minimally invasive or not, the pain afterward is brief and very manageable with oral pain medications.