Effectiveness of Thymectomy in Alleviating Myasthenia Gravis Symptoms: A Two-Decade Multicenter Experience from Pakistan

Background and Objectives: Thymectomy is an established therapeutic option for myasthenia gravis (MG), but long-term outcomes and predictors of remission from low- and middle-income countries remain limited. This study reports a 20-year, two-center experience evaluating surgical outcomes, neurological improvement, and prognostic factors following thymectomy. Methods: A retrospective analysis was conducted on 455 patients with MG who underwent thymectomy between January 2005 and December 2024 at two tertiary centers in Lahore, Pakistan. Neurological outcomes were assessed using the Myasthenia Gravis Foundation of America Post-Intervention Status. Univariate and multivariate logistic regression analyses were performed to identify predictors of favorable outcomes, defined as complete stable remission (CSR) or pharmacologic remission. Results: The mean age was 36.8 ± 13.1 years, with a female predominance (62.4%). Transsternal thymectomy was performed in 63.1% of patients and video-assisted thoracoscopic in 36.9%. Thymic hyperplasia was the most common pathology (55.2%), followed by thymoma (37.8%). At a mean follow-up of 74 ± 38 months, symptomatic improvement was achieved in 85.3% of patients. CSR and pharmacologic remission were observed in 31.2% and 24.6% of patients, respectively. Medication requirements declined significantly postoperatively ( P < 0.001). Five-year recurrence-free survival was 93.2%, and overall survival was 96.4%. Multivariate analysis identified shorter disease duration (<24 months) and non-thymomatous pathology as independent predictors of favorable neurological outcomes. Conclusions: Thymectomy was associated with durable neurological improvement and a significant reduction in medication dependence among patients with MG. Early surgical intervention, particularly in patients with non-thymomatous disease, was associated with better long-term outcomes, while minimally invasive approaches offered comparable efficacy with reduced perioperative morbidity.