Abstract
Previous studies addressing preoperative steroid treatment have revealed that control of myasthenia gravis (MG) with steroids prior to surgery appeared to stabilize postoperative status. The purpose of our study was to clarify the clinical benefits of the preoperative programmed high-dose steroid treatment on the long-term outcomes of MG patients. We retrospectively reviewed the records of 171 MG patients who were followed up after undergoing thymectomy in our hospital between 1988 and 2006. One hundred and thirteen patients in the programmed treatment group had received preoperative steroid treatment, while 58 patients received no steroid treatment during the preoperative period. Clinical remission, which was defined as the achievement of the modified pharmacologic remission (PR) for at least 1 year, and clinical benefits were compared between the two groups. With regard to the remission after thymectomy, Kaplan-Meier life-table curves for patients in the preoperative steroid treatment group versus those for patients in the no steroid preoperative treatment group revealed a significantly higher probability of the PR in the preoperative steroid treatment group (log-rank test, P < 0.01). This study might be the first, as per our knowledge, to indicate that preoperative programmed high-dose steroid treatment has long-term beneficial effects for MG patients.
Highlights
The prognosis of myasthenia gravis (MG) has improved dramatically because of advances in critical care medicine and symptomatic treatments
Several studies of steroid treatment for MG found that remission or a marked improvement occurred in approximately 80% cases, and high-dose steroids are universally preferred for remission induction [1]
Preoperative steroid treatment seems to stabilize postoperative respiratory status without having adverse effects such as surgical infection in MG patients, and some studies have reported that thymectomy had no negative impact on morbidity and mortality in MG patients; the outcomes of patients taking steroids were better [3,4,5,6]
Summary
The prognosis of myasthenia gravis (MG) has improved dramatically because of advances in critical care medicine and symptomatic treatments. MG patients have undergone thymectomy after programmed high-dose steroid treatment at our hospital since 1991. Endo et al reported that programmed high-dose steroid treatment in MG patients is feasible and provides clinical benefits for preoperative fluctuating symptoms at our hospital [3]. Preoperative steroid treatment seems to stabilize postoperative respiratory status without having adverse effects such as surgical infection in MG patients, and some studies have reported that thymectomy had no negative impact on morbidity and mortality in MG patients; the outcomes of patients taking steroids were better [3,4,5,6]. The primary benefit reported in these studies is stabilization of the postoperative status of MG patients, and no adverse effects of steroid therapy, such as surgical site infection or postoperative complications, were noted. Some researchers are of the opinion that steroid treatment should be avoided if possible because they increase the risk of side effects and that preoperative
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