Thymektomie bei Myasthenie und/oder Thymom

Zusammenfassung

Eine Thymektomie bezeichnet die operative Entfernung der Thymusdrüse. Bei einem Thymom besteht eine absolute Operationsindikation. In der Mehrzahl der Fälle einer Myasthenia gravis (MG) ist eine relative Indikation zur Thymektomie gegeben, die eine Kooperation mit spezialisierten Neurologen erfordert. Patienten mit einer MG können einen Tumor der Thymusdrüse aufweisen. In der präoperativen Diagnostik muss bei Thymomverdacht die Resektabilität bewertet werden. Patienten mit einer MG müssen präoperativ in einen stabilen Zustand gebracht werden. Die Thymektomie erfordert mit der Zielstellung einer radikalen Entfernung des Thymoms und/oder der weitestgehenden Besserung der MG eine komplette Entfernung der Thymusdrüse einschließlich allen häufig ektopen Thymusgewebes im Mediastinum. Die operativen Techniken zur Durchführung einer kompletten Thymektomie sind vielfältig, wobei neben den konventionellen Techniken mit einer Sternotomie die minimalinvasiven Verfahren zunehmend an Bedeutung gewinnen. Obwohl die Datenlage höherer Evidenz zur Thymektomie nach wie vor spärlich ist, werden zunehmend Ergebnisse zur Gleichwertigkeit minimalinvasiver Operationstechniken bei Thymektomie wegen MG und bei Thymektomie wegen Thymom verfügbar. Die erfolgreiche chirurgische Durchführung einer Thymektomie ist Bestandteil einer interdisziplinären Kooperation in der perioperativen Behandlung der MG sowie der postoperativen Langzeitbetreuung bei MG und/oder Thymom.

Abstract

Thymectomy, the surgical removal of the thymic gland, is essential in cases of thymoma. The majority of cases of a myasthenia gravis (MG) represent a relative indication for thymectomy which requires cooperation with specialized neurologists. Patients with MG may present with a tumor of the thymic gland. In case of suspicious thymoma, the resectability of the tumor has to be evaluated in the preoperative diagnostic. The clinical condition of patients with MG has to be stabilized preoperatively. The aim of thymectomy is the radical removal of thymoma and/or maximal improvement of MG symptoms. This requires the complete extirpation of the thymic gland including all ectopic thymic tissue in the anterior mediastinum. There is a variety of surgical techniques for performing a complete thymectomy. In addition to the conventional techniques with sternotomy, the significance of minimally-invasive approaches is increasing rapidly. Despite the ongoing scarcity of data of higher evidence concerning the procedure of thymectomy an increasing number of equivalent results with minimally-invasive operation techniques for MG and for thymoma are available. The successful surgical performance of a thymectomy is part of an interdisciplinary cooperation in the perioperative treatment of MG as well as the postoperative long-term care for patients with MG and/or thymoma.

Key words

Thymektomie - Myasthenia gravis - Thymom - Sternotomie - Thorakoskopie - Roboterchirurgie

Key words

thymectomy - myasthenia gravis - thymoma - sternotomy - thoracoscopy - robotic surgery

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