A mini-invasive approach is feasible in patients with primary hyperparathyroidism and discordant or negative localisation studies

Canu, Gian Luigi; Cappellacci, Federico; Noordzij, J. Pieter; Piras, Stefano; Erdas, Enrico; Calò, Pietro Giorgio; Medas, Fabio

doi:10.1007/s13304-021-01213-1

Cited by 1 publication

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References 32 publications

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“…However, with the use of intraoperative PTH, it has been reported that UNE with intraoperative PTH can be performed in 28–36% of patients with negative or inconsistent imaging. [ 12 , 21 , 22 ] It has been reported by Nehs et al that intraoperative PTH and UNE application may increase the operation time in patients with imaging inconsistency compared to BNE, especially due to waiting for the PTH result. The authors emphasized that BNE is still an excellent option as the first surgical intervention, especially in patients with discordant imaging.…”

Section: Discussionmentioning

confidence: 99%

The role of bilateral neck exploration for primary hyperparathyroidism in the minimally invasive parathyroidectomy era

Unlu¹

2022

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Objectives: In recent years, together with the contribution of new imaging methods, minimally invasive parathyroidectomy (MIP) has become the standard procedure in selected patients with the primary hyperparathyroidism (pHPT). However, some patients may still need bilateral neck exploration (BNE). In this study, we aimed to evaluate the factors associated with the necessity of BNE. Methods: Data of the patients, operated by same single surgeon in between 2010 and 2019, were evaluated retrospectively. Patients were divided into two groups as MIP group (group 1) and BNE group (group 2). The risk factors associated with necessity of BNE were evaluated. Results: Three hundred and forty-four patients (288 females and 56 males) were included in study. The mean age was 54.1±12.8. Pre-operative parathormone level (288 pg/mL vs. 190 pg/mL, p<0.001; respectively), compatible, inconsistent and negative imaging on scintigraphy (82.5% vs. 28.7%, 9.6% vs. 19.1, 7.9% vs. 52.25%, p<0.001; respectively), compatible, inconsistent and negative imaging in ultrasonography (USG) (72.9% vs. 20%, 7% vs. 19.1%, 20.1% vs 60.9%, p<0.001; respectively) in combination of USG and scintigraphy, two positive, single positive and negative imaging (72.5% vs. 11.3%, 25.8% vs. 55.7%, 1.7 vs. 33%, p<0.001; respectively), single adenoma, double adenoma, hyperplasia rates in pathology (96.1% vs. 79.1%, 3.1% vs. 12.2%, 0.9% vs. 8.7%, p<0.001; respectively), concomitant thyroidectomy (11.4% vs. 38.3%, p<0.001; respectively), diameter of the removed gland (2.03 vs. 1.58 cm, p<0.001; respectively), and volume of the removed gland (2.27 vs. 1.22 cm 3 , p<0.001; respectively), were significantly different in group 1 compared to group 2. Low pre-operative parathormone, discordant pathological gland localization compared to pathological gland compatible with scintigraphy images (odds ratio [OR]: 3.690; p=0.027), negative scintigraphy images (OR: 9.174, p=0.000), and need for additional thyroidectomy (OR: 5.067); p=0.000) were determined as independent risk factors increasing the need for BNE in the multinomial logistic regression analysis. Long-term cure rates were similar (98.3% vs. 94.8%, p=0.079; respectively). Conclusion: At present, BNE may be necessary in the surgical treatment of a significant proportion of patients with pHPT. According to our results, the possibility of BNE requirement is higher in patients with low PTH level compared to pre-operative high PTH values, in patients with discordant and negative scintigraphy compared to positive and compatible scintigraphy, and in patients who will undergo additional thyroidectomy. We think that BNE is not an alternative to MIP, but an effective option that is complementary to MIP to achieve optimal results in parathyroid surgery.

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Section: Discussionmentioning

confidence: 99%

The role of bilateral neck exploration for primary hyperparathyroidism in the minimally invasive parathyroidectomy era

Unlu¹

2022

Sisli Etfal

View full text Add to dashboard Cite

show abstract

A mini-invasive approach is feasible in patients with primary hyperparathyroidism and discordant or negative localisation studies

Cited by 1 publication

References 32 publications

The role of bilateral neck exploration for primary hyperparathyroidism in the minimally invasive parathyroidectomy era

The role of bilateral neck exploration for primary hyperparathyroidism in the minimally invasive parathyroidectomy era

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