timectomía

Timectomía, or thymectomy, is the surgical removal of the thymus gland, located in the anterior superior mediastinum behind the sternum. Indications are both oncologic and autoimmune. The most common are thymoma and myasthenia gravis (MG). Thymic hyperplasia, thymic cysts, and, less commonly, autoimmune conditions such as pure red cell aplasia may also be treated with thymectomy. In MG, removing the thymus may reduce autoantibody production and improve neuromuscular transmission in selected patients.

Approaches include open transsternal thymectomy, which removes the thymus and surrounding mediastinal fat, and minimally invasive methods such as video-assisted thoracoscopic thymectomy (VATS) or robotic thymectomy. The choice depends on thymus size, invasion, and surgeon experience. The goal is complete thymic tissue removal and resection of anterior mediastinal fat; pathology confirms thymic tissue and detects thymoma or hyperplasia.

Outcomes depend on indication. In MG, thymectomy can improve symptoms and lower disease burden, especially in generalized MG and non-thymomatous disease; some patients achieve remission after several years. For thymoma, thymectomy is the main oncologic operation, often followed by radiotherapy or chemotherapy based on stage. Complete resection offers the best prognosis; prognosis relates to stage and histology.

Complications are uncommon but may include infection, bleeding, mediastinal injury, pneumothorax, and injury to the phrenic or recurrent laryngeal nerves. Recovery depends on the approach and comorbidities and may require a short stay in hospital or ICU. Long-term follow-up includes clinical assessment and, when indicated, imaging and histopathology review.