Myasthenia gravis and thymectomy: many doubts and few certainties

Myasthenia gravis (MG) is a rare autoimmune disease affecting neuromuscular transmission. The thymus plays a central role in the complex pathogenesis and perpetuation of this disease, being implicated in mechanisms of self-tolerance and autoimmunity. Since the study of Blalock [1] in 1944, who published the results of transternal thymectomy in a series of 20 patients affected by MG, thymectomy has become an essential part of the integrated treatment of this disease, yielding positive results in terms of im-provement and remission of symptoms. The report by Keijzers et al. [2] in this issue of EJCTS provides the neurological and surgical results of robotic thymectomy in a large cohort of patients affected by MG. This study summarizes the main concerns regarding the role of thymectomy in MG patients. Despite a general agreement on the beneficial role of thymec-tomy for MG patients, to date no prospective randomized trial