Is Focused Minimally Invasive Parathyroidectomy Appropriate for Patients With Familial Primary Hyperparathyroidism?

Prichard, Ruth; OʼNeill, Christine; Oucharek, Jennifer J.; Sippel, Rebecca S.; Delbridge, Leigh; Sidhu, Stanley; Chen, Herbert

doi:10.1245/s10434-011-2092-6

Cited by 10 publications

(8 citation statements)

References 25 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…One major drawback of SPTX and TPTX, however, is their reported high rate of permanent postoperative hypoparathyroidism of up to 66% (Table ), which was also the case in the present study with 32% after TPTX and 17% after SPTX, respectively. All patients after TPTX developed a transient postoperative hypoparathyroidism requiring substitution therapy.…”

Section: Discussionsupporting

confidence: 76%

“…Therefore, recent practice guidelines previously recommended SPTX or TPTX as procedures of choice for this condition, since rates of recurrence and postoperative hypoparathyroidism rates were acceptable during short‐term follow‐up (Table ). In the literature, the recurrence rate after TPTX varies between 0% and 60% compared with 4.4% in the present study. Some authors preferring TPTX report lower recurrence and disease persistence rates compared with SPTX .…”

Section: Discussioncontrasting

confidence: 48%

“…However, in the last years few authors have favoured a unilateral approach to avoid permanent postoperative hypoparathyroidism. 3,[9][10][11][12][13] A unilateral approach or even focused single gland excision is considered justified, if preoperative diagnostic procedures (ultrasonography and/or 99mTc-MIBI scintigraphy) reveal unilateral or single enlarged parathyroid glands. In these cases, a targeted resection of one or two glands might be performed, if the intraoperative quick PTH measurement (IOPTH) reveals a drop of the intact serum parathyroid hormone level in the normal range after excision of hyperplastic gland(s).…”

Section: Introductionmentioning

confidence: 99%

“…Current clinical practice guidelines1 recommend at least subtotal parathyroidectomy with bilateral cervical thymectomy (SPTX) or total parathyroidectomy with cervical thymectomy and autotransplantation of parathyroid tissue (TPTX). However, in the last years few authors have favoured a unilateral approach to avoid permanent postoperative hypoparathyroidism 3-13. A unilateral approach or even focused single gland excision is considered justified, if preoperative diagnostic procedures (ultrasonography and/or 99mTc‐MIBI scintigraphy) reveal unilateral or single enlarged parathyroid glands.…”

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

Single gland excision for MEN1‐associated primary hyperparathyroidism

Manoharan

Albers

Bollmann

et al. 2019

Clinical Endocrinology

View full text Add to dashboard Cite

Importance: Guidelines advocate subtotal parathyroidectomy (SPTX) or total parathyroidectomy with autotransplantation (TPTX) with bilateral cervical thymectomy for primary hyperparathyroidism (pHPT) associated with multiple endocrine neoplasia type 1 (MEN1). However, both procedures are associated with a significant risk of permanent hypoparathyroidism. Objective:The aim of the current study was to compare long-term results of either single gland excision (SGE, 1-2 glands), SPTX and TPTX for the treatment of MEN1associated pHPT.Design and setting: Data of genetically confirmed MEN1 patients who underwent surgery for pHPT between 1987 and 2017 were retrieved from a prospective database and were retrospectively analysed.Results: Eighty-nine MEN1 patients underwent either TPTX (n = 38, 42.7%), SPTX (n = 23, 25.8%) or SGE (n = 28, 31.5%). The rate of disease persistence after initial surgery was 2.6%, 0% and 14.2% in the TPTX, SPTX and SGE groups, respectively.After median follow-up of 112 (range 7-411) months, the rate of recurrent pHPT was significantly higher in the SGE group (n = 19, 21.3%) compared with the TPTX (n = 4, 4.4%, P = .001) and the SPTX (n = 9, 10.1%, P = .03) groups. Analysis of the recurrence-free time among the surgical groups revealed a significant difference (P = .036). The median time to recurrence was significantly shorter after SGE (101, range 3-301 months) than after SPTX (139, range 28-278 months, P = .018) and TPTX (204, range 75-396 months, P = .049). Twelve (32%) patients who underwent TPTX developed permanent hypoparathyroidism compared with only 4 (17%, P = .06) in the SPTX and 0 in the SGE group (P = .001). Conclusion:Given the high rate of postoperative permanent hypoparathyroidism after TPTX and SPTX, SGE is a valid option for the treatment of MEN1-associated pHPT. K E Y W O R D Shypocalcemia, hypoparathyroidism, laryngeal nerve palsy, multiple endocrine neoplasia type 1, primary hyperparathyroidism, recurrence, surgery

show abstract

Section: Discussionsupporting

confidence: 76%

Section: Discussioncontrasting

confidence: 48%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Single gland excision for MEN1‐associated primary hyperparathyroidism

Manoharan

Albers

Bollmann

et al. 2019

Clinical Endocrinology

View full text Add to dashboard Cite

show abstract

“…Trans-cervical thymectomy is usually performed, during both these procedures, to prevent thymic carcinoid and remove possible ectopic parathyroid glands ( 5 ). However, some reports have shown that limited excision of the affected parathyroid glands could obtain the same result in correcting the hypercalcemia, with a lower risk of persistent hypoparathyroidism ( 6 – 8 ).…”

Section: Introductionmentioning

confidence: 99%

Total and Subtotal Parathyroidectomy in Young Patients With Multiple Endocrine Neoplasia Type 1-Related Primary Hyperparathyroidism: Potential Post-surgical Benefits and Complications

et al. 2018

View full text Add to dashboard Cite

Background: The choice of surgical treatment for patients with Multiple Endocrine Neoplasia type 1 (MEN1)-related primary hyperparathyroidism (PHPT) remains controversial and it has not been specifically addressed in young patients.Methods: This is a retrospective case series study. The study includes the surgical data and the follow-up of 38 patients younger than 30 years of age, all diagnosed with MEN1, collected and followed-up between 1991 and 2017 at the Regional Referral Center for Inherited Endocrine Tumors of the Tuscany Region, and operated by parathyroidectomy. Genetic and/or clinical MEN1 diagnosis was made before surgery in all patients. Subtotal (9/38 patients) or total parathyroidectomy with auto-transplantation (28/38 patients) were performed in all patients but one, in whom a single mediastinal adenoma was excised from the aorto-pulmonary window. All patients but one, who was operated in 2017, had a post-operatory follow-up of at least 12 months.Results: Total parathyroidectomy (TPTX), with auto-transplantation, was the most frequently adopted operation both as primary (20/38 patients) and secondary (8/38 patients) surgery, followed by subtotal parathyroidectomy (SPTX; 9/38 patients) and limited parathyroidectomy (1/38 patient). At follow-up, lasting a mean of 11.8 ± 6.6 years (range 0–23 years), no persistent PHPT was observed. PHPT recurred in 4/28 TPTX (14%) and in 2/9 SPTX (22%). Permanent hypoparathyroidism showed no statistically significant difference between the procedures (2/9 in SPTX and 5/28 in TPTX).Conclusions: Data from this retrospective study showed the efficacy of TPTX for the treatment of MEN1-PHPT, also in adolescent and young patients, showing, in our series, no risk of PHPT permanence and a longer disease-free period and, subsequently, the possibility to postpone re-intervention with respect to both limited PTX and SPTX. The risk of permanent hypoparathyroidism in TPTX was comparable to STPX, and could be mitigated over the years.

show abstract