Focused Versus Bilateral Parathyroid Exploration for Primary Hyperparathyroidism: A Systematic Review and Meta-analysis

Jinih, Marcel; OʼConnell, Emer; O’Leary, Donal Peter; Liew, Aaron; Redmond, H. P.

doi:10.1245/s10434-016-5694-1

Cited by 52 publications

(40 citation statements)

References 37 publications

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“…The literature has suggested that approximately 2–5 per cent of PHPT patients will require further surgery for persistent or recurrent disease . In our study, one patient in groups 1 (2.4 per cent) and group 2 (0.7 per cent) developed persistent hypercalcaemia after the operation, which ultimately resulted in a second surgery for removal of a second adenoma; this is consistent with international standards.…”

Section: Discussionsupporting

confidence: 88%

Is day surgery for minimally‐invasive parathyroidectomy a feasible option?

Tai

2019

Surgical Practice

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Aim:The aim of the present study was to explore the safety of day surgery for minimally-invasive parathyroidectomy (MIP) in the treatment of primary hyperparathyroidism (PHPT). Patients and Methods: The records of all patients who underwent minimally-invasive parathyroidectomies for PHPT from January 2001 to December 2017 at our centre were reviewed. Patients who underwent bilateral neck exploration, reoperation and concomitant procedures, such as hemithyroidectomy, were excluded. Patients were placed into two groups: group 1 included day surgery cases, and group 2 included patients who were admitted 1 day before the operation and discharged >1 day after the operation. Patient demographics and clinical outcomes were compared between the two groups. Results: Overall, 194 patients were included: 42 in group 1 and 152 in group 2. There was no statisticallysignificant difference between the mean age (P = 0.094), percentage of female patients (P = 0.072), American Society of Anesthesiologists score (P = 0.659) and preoperative and postoperative blood calcium level (P = 0.252 and P = 0.097, respectively) between the two groups. There was also no statistically-significant difference between the two groups in terms of outcomes, such as bleeding/haematoma (P = 0.598), wound infection (P = 0.328), recurrent laryngeal nerve injury (P = 0.234), postoperative hypocalcaemia (P = 0.082), recurrent/persistent disease (P = 0.328), revisit to the Accident and Emergency Department within 30 days of discharge (P = 0.446), unplanned readmission (P = 0.359) and death (P = 0.598). Conclusions: Overall, we believe that our data indicate that day surgery is a feasible and safe option for patients undergoing MIP for PHPT.

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Section: Discussionsupporting

confidence: 88%

Is day surgery for minimally‐invasive parathyroidectomy a feasible option?

Tai

2019

Surgical Practice

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“…Of the 14 studies, seven were retrospective 11,26 -31 , six involved collection of prospectively identified items 20,32 -36 and one 37 did not clarify the type of study. The median MINORS score was 10 of 16 (mean 9⋅8, range [6][7][8][9][10][11][12][13][14] for all studies, and the median of the four comparative studies 11,20,26,28 was 15 of 24 (mean 14⋅25, range 10-17). According to the OCEM criteria, all of the included studies were classified as individual cohort studies and were therefore classified as having level 2b evidence.…”

Section: Quality Of Studies and Levels Of Evidencementioning

confidence: 98%

“…Rapid intraoperative parathyroid hormone (IOPTH) assay, sestamibi scintigraphy and radio‐guided parathyroidectomy have emerged, facilitating the development of ‘targeted’ parathyroidectomy techniques based on single‐gland excision via unilateral neck exploration. Various techniques have been described, with a general consensus that parathyroidectomy is classified as ‘minimally invasive’ when performed with preoperative localization through an incision of less than 2·5–3 cm , .…”

Section: Introductionmentioning

confidence: 99%

“…Targeted minimally invasive parathyroidectomy (MIP) has been shown in large studies, systematic reviews and meta‐analysis to be highly effective with low complication rates compared with open bilateral neck exploration (BNE). Advantages of MIP include shorter duration of surgery, lower rates of postoperative hypocalcaemia, less postoperative pain and a smaller scar.…”

Section: Introductionmentioning

confidence: 99%

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Systematic review of cure and recurrence rates following minimally invasive parathyroidectomy

et al. 2018

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BackgroundThe majority of patients with primary hyperparathyroidism (PHPT) have a single overactive adenoma. Advances in preoperative imaging and surgical adjuncts have given rise to minimally invasive parathyroidectomy (MIP), with lower complication rates in comparison with bilateral neck exploration. Misdiagnosis and undertreatment of multiglandular disease, leading to potentially higher recurrence rates, remains a concern. This study evaluated risks of long‐term (1 year or more) recurrence following ‘targeted’ MIP in PHPT.MethodsMultiple databases were searched for studies published between January 2004 and March 2017, looking at long‐term outcomes (1 year or more) following targeted MIP for PHPT. English‐language studies, with at least 50 patients and a mean follow‐up of 1 year, were included.ResultsA total of 5282 patients from 14 studies were included. Overall mean recurrence and cure rates were 1·6 (range 0–3·5) and 96·9 (95·5–100) per cent respectively. Mean follow‐up was 33·5 (1–145) months. When intraoperative parathyroid hormone (PTH) measurements were not done, cure rates were higher (99·3 per cent versus 98·1 per cent with use of intraoperative PTH measurement; P < 0·001) and recurrence rates lower (0·2 versus 1·5 per cent respectively; P < 0·001).ConclusionTargeted MIP for a presumed single overactive adenoma was associated with very low recurrence rates, without the need for intraoperative PTH measurement when preoperative imaging studies were concordant. Targeted MIP should be encouraged.

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“…Although multigland disease was higher in the BNE group than focused parathyroidectomy group (16.4% vs 5.7%), rates of persistent disease (2.4% vs 2.3%), recurrent disease (0.8% vs 1.25%), total failure (3.3% vs. 3.6%) and reoperation (1.3% vs 2.2%) were comparable. [53] The high rate of multigland disease in the BNE group is related to patient selection for different types of surgery. Focused surgical imaging is performed in selected disease-positive patients.…”

Section: Bne or Mip In Surgical Treatment Of Primary Hyperparathyroidismmentioning

confidence: 99%

Surgical Treatment Of Primary Hyperparathyroidism: Which Therapy To Whom?

Aygün¹

2019

Sisli Etfal

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Primary hyperparathyroidism (pHPT) is characterized by an increase in the levels of PTH and Ca, or one of these (Ca, PTH) as a result of a dysregulation of calcium (Ca) metabolism due to inappropriate excess parathyroid hormone (PTH) autonomously produced from one or more than one parathyroid glands. Ninety to 95% of pHPT is a sporadic type, which is not associated with the familial history and other endocrine organ tumors, and 5-10% of it is hereditary. While 80-85% of pHPT arises from a single parathyroid adenoma, 4-5% is caused by a double adenoma, 10-15% by multigland hyperplasia and less than 1% by parathyroid cancer. The diagnosis of pHPT is reached biochemically. The only curative treatment of pHPT is surgery. The choice of surgery in pHPT may vary depending on whether the patient has hereditary HPT or thyroid disease requiring surgical treatment, preoperative localization studies and the findings in these studies, the possibilities of using intraoperative PTH and the preference of the surgeon. The preoperatively determined surgical strategy can be revised according to intraoperative findings in case of need to achieve excellent results. The two main approaches in the surgical treatment of pHPT are BNE (bilateral neck exploration) and MIP (minimal invasive parathyroidectomy). Although BNE is a consistently valid option that has excellent results in the surgical treatment of pHPT and is considered the gold standard, MIP is the ideal approach in selected patients with clinically and radiologically considered a single-gland disease. Negative imaging is not a contraindication for parathyroid surgery and is not a criterion for the presence or absence of surgical indication. Although both methods are safe and effective in the surgical treatment of sporadic pHPT, there is still controversy regarding the effectiveness of both methods. Surgical intervention should establish the risk-benefit balance well, minimize the risk of persistent and recurrent disease and provide the highest cure rate without increasing the risk of complications. Complication rates are higher in the secondary surgery, thus in secondary procedures, selective surgery should be performed under guidance of an imaging modality. The surgical strategy should be determined to achieve maximum cure with minimum dissection and minimal morbidity. In this study, we aimed to determine the type of surgical treatment and pHPT patients suitable for the surgical treatment.

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Focused Versus Bilateral Parathyroid Exploration for Primary Hyperparathyroidism: A Systematic Review and Meta-analysis

Abstract: Compared with BE, FE has similar recurrence, persistence, and reoperation rates but significantly lower overall complication rates and shorter operative time.

Cited by 52 publications

References 37 publications

Is day surgery for minimally‐invasive parathyroidectomy a feasible option?

Is day surgery for minimally‐invasive parathyroidectomy a feasible option?

Systematic review of cure and recurrence rates following minimally invasive parathyroidectomy

Surgical Treatment Of Primary Hyperparathyroidism: Which Therapy To Whom?

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