TOPLINE

Thymectomy was not associated with increased risk for all-cause mortality or cancer incidence at 10 years compared with cardiothoracic procedures. Among patients undergoing thymectomy, those who underwent surgery for thymic malignancy had more than double the mortality risk.

METHODOLOGY

• Researchers conducted a propensity score-matched retrospective cohort study to assess the long-term health consequences of thymectomy, comparing 398 patients who underwent thymectomy with 398 control individuals who underwent coronary artery bypass grafting or valve surgery.
• Participants were matched by age and sex. Before matching, the median age in the thymectomy group was 54 years and 50.4% were women, compared with 67 years and 32.6% women in the control group.
• The primary outcome was all-cause mortality from 91 days after surgery through 10 years of follow-up. Secondary outcomes were new-onset malignancy and autoimmune disease diagnosed more than 90 days postoperatively.

TAKEAWAY

• Thymectomy was not associated with increased risk for all-cause mortality compared with cardiothoracic procedures, at 5 or 10 years after surgery.
• Cumulative cancer incidence at 10 years was identical in thymectomy and control groups (4.3%); at 5 years, incidence was numerically higher after thymectomy (3.5% vs 1.8%; P = .053), driven partly by reclassified thymic malignancies.
• Within the thymectomy cohort, patients with thymic malignancy had significantly higher mortality (hazard ratio [HR], 2.42; P = .001), while those with myasthenia gravis showed a nonsignificant trend toward lower mortality.
• At 10 years, immune-related disease occurred in 4.5% of patients in the thymectomy group and 2.5% of those in the control group, with no significant difference between the groups.

IN PRACTICE

"These findings support the absence of a clear increased risk from thymectomy when clinically indicated, while emphasizing that incidental or non-essential thymic removal should be approached with caution," wrote the authors of the study.

SOURCE

The study was led by Shahar Shelly, Rappaport Faculty of Medicine, Technion-Israel Institute of Technology in Haifa, Israel. It was published online on August 1 in European Journal of Neurology.

LIMITATIONS

This single-center retrospective analysis is subject to residual confounding. Cancer ascertainment may be influenced by differential imaging intensity, with patients undergoing thymectomy receiving more intensive oncologic surveillance. Subgroup analysis for myasthenia gravis was underpowered due to very few events, limiting interpretation.

DISCLOSURES

No specific funding was reported. The authors reported no relevant conflicts of interest.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.