Researchers found that myasthenia gravis (MG) grade 3 and the preoperative administration of anti-MG drugs are associated with a higher incidence of severe respiratory failure and a greater need for postoperative ventilator support after thymoma surgery, as published in the Journal of Surgical Research.

They also noted additional risk factors such as sex, Masaoka thymoma stage, surgical approach, pulmonary function test values, and blood loss were related to the need for postsurgical ventilator support.

“In the present study, we found that 17.8% (28/157) of patients undergoing tumor resection developed severe postoperative respiratory failure requiring ventilator support, with the number of male patients requiring post-surgical respiratory support therapy greater than that of females,” the authors wrote.

“This result may be associated with the observed high proportion of male patients (90.9%) in our study with grade three MG, as consistent with results of a previous study showing that late-onset MG is more common in males, while also showing that MG patients are prone to respiratory muscle weakness.”

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The research team investigated predictors of postoperative respiratory support in 157 patients with MG undergoing thymoma resection at a single center between 2001 and 2020. Specifically, in addition to the MG grade and use of anti-MG drugs, the median sternotomy surgical approach resulted in a 12.5-fold increase in the likelihood of requiring postoperative ventilatory support.

This increase could be due to the fact that this procedure is associated with a higher rate of intraoperative bleeding, and in fact, blood loss greater than 1000 mL was also associated with a greater risk of severe respiratory failure and a need for ventilatory support.

The authors recommend early detection of thymomas and close monitoring of patients with the identified risk factors to reduce the incidence of severe respiratory failure after surgery.


Ruan H, Lin S, Liu F, et al. Key factors associated with administration of ventilator support after thymoma resection. J Surg Res. Published online April 22, 2022. doi:10.1016/j.jss.2022.03.020