Association Between Pleural Breach and Perioperative and Long-Term Outcomes after Thymectomy for Myasthenia Gravis: A Two-Center Retrospective Study

OBJECTIVE: Thymectomy is an established treatment for myasthenia gravis and thymic tumors.This study evaluated the impact of pleural breach on perioperative pleural-related morbidity and long-term neurologic and oncologic outcomes following thymectomy. MATERIAL AND METHODS:A retrospective multicenter review of 455 patients who underwent thymectomy between January 2005 and December 2024 was conducted at Services Hospital and Surgimed Hospital, Lahore, Pakistan.Patients underwent either a partial transsternal thymectomy (n = 273) or a video-assisted thoracoscopic surgery (VATS) thymectomy (n = 182).The primary outcome was pleural-related postoperative morbidity.Secondary outcomes included neurologic remission, recurrence-free survival (RFS), postoperative complications, and hospital stay.RESULTS: Pleural breach occurred in all VATS cases and incidentally in 29 (10.6%)transsternal cases.VATS thymectomy was associated with lower blood loss (P < 0.001) and shorter hospital stay (P < 0.001), but with longer operative time (P < 0.001).Pleuralrelated complications were more frequent following pleural breach, but were generally transient and were managed conservatively.On multivariable analysis, pleural breach independently predicted pleural-related morbidity [odds ratio (OR): 2.6, P = 0.006].The combined proportion of patients achieving complete stable remission, pharmacologic remission, or clinical improvement exceeded 90%.Neurologic remission and 5-year RFS were comparable between groups (P = 0.612 and P = 0.538, respectively).CONCLUSION: Pleural breach during thymectomy was independently associated with increased transient pleural-related postoperative morbidity (OR: 2.6).However, these complications were generally self-limited and managed conservatively.Long-term neurologic remission and RFS were comparable between surgical approaches, but these findings should be interpreted cautiously given the retrospective observational design.