Outcomes of Parathyroidectomy in Patients with Primary Hyperparathyroidism: A Systematic Review and Meta‐analysis

Ospina, Naykky M Singh; Rodríguez-Gutiérrez, René; Maraka, Spyridoula; Ycaza, Ana E. Espinosa De; Jasim, Sina; Castañeda-Guarderas, Ana; Gionfriddo, Michael R.; Nofal, Alaa Al; Brito, Juan P.; Erwin, Patricia J.; Richards, Melanie L.; Wermers, Robert A.; Montori, Víctor M.

doi:10.1007/s00268-016-3514-1

Cited by 102 publications

(74 citation statements)

References 138 publications

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“…Our data is completely consistent with the findings from large systematic reviews and meta‐analyses evaluating MIP and bilateral neck exploration (BNE) including one completed by Ospina and colleagues in 2016. In their meta‐analysis of 88 published studies, cure rates were reported to be 97% for MIP and 98% for BNE with four‐gland dissection . Of note, hypocalcemia occurred in 14% of BNE cases versus 2.3% in MIP cases, and there was also a statistically significant lower risk of laryngeal nerve injury with MIP compared to BNE (0.3% vs. 0.9%).…”

Section: Discussionmentioning

confidence: 99%

“…Multiple studies have shown that image‐guided, ioPTH‐assisted minimally invasive parathyroidectomy (MIP) results in cure rates equivalent to that of conventional BNE with four‐gland dissection . Despite this, a parathyroid surgical group based, which had previously been staunch proponents of minimally invasive parathyroid surgery (calling “bilateral neck exploration for all parathyroid patients an operation for the history books”), changed their approach in 2012 and now are dogmatic advocates for universal BNE with four‐gland dissection .…”

Section: Introductionmentioning

confidence: 99%

“…Although the more typical MIP technique has yielded excellent short‐term cure rates, several studies have cited the need for more extended follow‐up to confirm the durability of the results . We therefore analyzed 10 years of MIP data to assess the long‐term outcomes of this procedure as compared to published long‐term cure rates of BNE with four‐gland dissection …”

Section: Introductionmentioning

confidence: 99%

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Routine bilateral neck exploration and four‐gland dissection remains unnecessary in modern parathyroid surgery

Walsh

Sullivan

Duke

et al. 2018

Laryngoscope Investig Oto

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Objective Recent advances in preoperative imaging techniques and intraoperative parathyroid hormone (ioPTH) assays have made single‐gland, minimally invasive parathyroidectomy (MIP) the preferred treatment option for most patients with primary hyperparathyroidism (pHPT). Despite this evolution, a recommendation for bilateral neck exploration (BNE) with four‐gland dissection in all patients has recently been advocated by a parathyroid surgical group. The current study compares the long‐term outcomes of MIP with those of conventional BNE with four‐gland dissection in patients with pHPT. Methods In order to objectively assess a recommendation in the literature that universal BNE with four‐gland dissection is advisable, all patients undergoing an initial MIP with ioPTH assessment for pHPT in a tertiary endocrine practice during a 10‐year period were reviewed. The cure rates from this procedure were compared with published results of conventional BNE with four‐gland dissection. Results Of the 561 patients undergoing parathyroidectomy during the study period, 337 had initial surgery for pHPT; 282 of these patients met inclusion criteria and 212 had sufficient follow‐up data available. A single adenoma was identified in 87.3% of cases. Preoperative imaging studies were co‐localizing in 148 (69.8%), and 127 (85.8%) of these patients with co‐localizing imaging required only single‐gland surgery. Imaging studies did not co‐localize in 49 patients, yet 32 (65.3%) of these patients were still cured with unilateral surgery. The cure rate for patients undergoing MIP was 98.6%, with a long‐term recurrence rate of <2%. Conclusion When coupled with the ioPTH assay, patients with at least one preoperative localizing study can undergo MIP and anticipate a cure rate of 99%, which is as good as or better than the published rates for conventional BNE with four‐gland dissection. With unilateral surgery, the risks of permanent hypoparathyroidism and airway obstruction from bilateral vocal fold paralysis are completely eliminated. Therefore, despite recommendations to the contrary, most patients with pHPT should not have a planned four‐gland exploration. Level of Evidence III or IV

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Routine bilateral neck exploration and four‐gland dissection remains unnecessary in modern parathyroid surgery

Walsh

Sullivan

Duke

et al. 2018

Laryngoscope Investig Oto

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“…Thereby from classical bilateral four gland exploration of PA an increasing number of unilateral focused minimally invasive techniques have been introduced in numerous centers including open minimal parathyroidectomy but also video-guided, radio-guided and endoscopic removal of PA with or without rapid intraoperative PTH assay reducing the cost and morbidity while maintaining cure rates (27,28,29).…”

Section: Discussionmentioning

confidence: 99%

Parathyroid Adenomas in Adults and Adolescents. Critical Appraisal and Surgical Strategy in 18 Cases

Diaconescu¹,

Ioan²,

Mihai³

et al. 2017

chr

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RezumatIntroducere: Studiul nostru subliniazã raritatea cazurilor de adenoame paratiroidiene (AP) publicate în literatura medicalã autohtonã, expresia clinicã diferitã în care predominã formele "istorice" ale bolii ca şi dificultãţile şi întârzierile de diagnostic confirmând totodatã chirurgia ca standardul de aur al tratamentului. Pacienţi şi metodã: Sunt analizate retrospectiv demografia, datele clinice, de laborator şi cele imagistice, procedurile chirurgicale şi constatãrile anatomopatologice ca şi rezultatele obţinute în 18 cazuri documentate de AP tratate chirurgical. Rezultate: Raportul m/f al cazurilor a fost de 1/5 iar vârsta acestora a variat între 16-58 (medie 46). Litiaza urinarã (n=9) şi leziunile osoase (n=6) au fost cele mai întâlnite manifestãri menţionate. Acestora li s-au adãugat tulburãri psihiatrice şi neuromusculare, cele digestive (pancreatita şi ulcerul peptic), hipertensiune arterialã ca şi prezenţa unui nodul palpabil. Diagnosticul a fost confirmat prin dozãrile calciului şi fosforului seric, fosfatazei alcaline şi PTH, ecografia şi scintigrafia cu techneţiu 99m. Au fost practicate 18 adenomectomii din care 16 dupã explorarea cervicalã bilateralã şi douã prin abord minim invaziv. În 9 situaţii s-a recurs la exereze tiroidiene concomitente pentru leziuni asociate sau în scop tactic. Examenul microscopic a confirmat diagnosticul de AP cu celule principale şi oxifile, într-un caz fiind identificat un adenom "atipic". Într-o altã observaţie, la 3 ani dupã exereza unui AP benign, s-a constatat o recidivã clinicã ipsilateralã care s-a dovedit a fi un carcinom (leziune nouã sau eroare a diagnosticului iniţial?). Evoluţia clinicã şi bioumoralã postoperatorie imediatã şi la distanţã a fost favorabilã în toate cazurile cu excepţia cazului de carcinom care a decedat dupã 14 luni de la reintervenţie. Concluzii: În pofida raritãţii şi dificultãţilor de diagnostic a cazurilor de AP, practicienii trebuie sã fie conştienţi de posibilitatea existenţei acestor leziuni în vederea unui tratament cât mai precoce şi adecvat în care chirurgia reprezintã standardul de aur. Original Article IntroductionPrimary hyperparathyroidism (PHP) is the third most common endocrine disorder after diabetes mellitus and thyroid illnesses, the case studies showing an estimated prevalence in general population of 0,5-1% and an annual incidence of 28 cases per 100000 people (1,2,3). Single gland sporadic parathyroid adenoma (PA) represents the most frequent cause (85-90%) of PHP cases. In the other affected patients hyperplasia, carcinoma and familial forms can occur (4,5). Demographics and clinical characteristics of PA underwent a dramatic change in the 1970s with the widespread availability of serum calcium screening by the multichannel autoanalyzer (6,7). Therefore the rare classical observations of PA diagnosed by consecrated clinical tetrad "painful bones, renal stones, abdominal groans and psychic moans" and objectification of hipercalcemia, become actually a common endocrine disease, 80% of cases appearing asymptomatic a...

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“…Both MIP and BNE have an excellent cure rate. In their recent meta-analysis, Ospina et al reported that the cure rate was 98% with BNE and 97% with MIP, with lower morbidity for MIP [18]. In a large series of patients, Lee et al reported that the major cause of operative failure was the surgeon's failure to identify abnormal glands and the absence of performing BNE in case of an inadequate decrease in intra-operative PTH levels (IOPTH) [19].…”

Section: Predictive Factors Of R-phpt or P-phptmentioning

confidence: 99%

Persistent and recurrent hyperparathyroidism

et al. 2017

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Despite remarkable progress in imaging modalities and surgical management, persistence or recurrence of primary hyperparathyroidism (PHPT) still occurs in 2.5-5% of cases of PHPT. The aim of this review is to expose the management of persistent and recurrent hyperparathyroidism. A literature search was performed on MEDLINE using the search terms "recurrent" or "persistent" and "hyperparathyroidism" within the past 10 years. We also searched the reference lists of articles identified by this search strategy and selected those we judged relevant. Before considering reoperation, the surgeon must confirm the diagnosis of PHPT. Then, the patient must be evaluated with new imaging modalities. A single adenoma is found in 68% of cases, multiglandular disease in 28%, and parathyroid carcinoma in 3%. Others causes (<1%) include parathyromatosis and graft recurrence. The surgeon must balance the benefits against the risks of a reoperation (permanent hypocalcemia and recurrent laryngeal nerve palsy). If surgery is necessary, a focused approach can be considered in cases of significant imaging foci, but in the case of multiglandular disease, a bilateral neck exploration could be necessary. Patients with multiple endocrine neoplasia syndromes are at high risk of recurrence and should be managed regarding their hereditary pathology. The cure rate of persistent-PHPT or recurrent-PHPT in expert centers is estimated from 93 to 97%. After confirming the diagnosis of PHPT, patients with persistent-PHPT and recurrent-PHPT should be managed in an expert center with all dedicated competencies.

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Outcomes of Parathyroidectomy in Patients with Primary Hyperparathyroidism: A Systematic Review and Meta‐analysis

Abstract: MIP and BNE are both effective surgical techniques for the treatment of primary hyperparathyroidism. The safety profile of MIP appears superior to BNE (lower rate of hypocalcemia and recurrent laryngeal nerve injury).

Cited by 102 publications

References 138 publications

Routine bilateral neck exploration and four‐gland dissection remains unnecessary in modern parathyroid surgery

Routine bilateral neck exploration and four‐gland dissection remains unnecessary in modern parathyroid surgery

Parathyroid Adenomas in Adults and Adolescents. Critical Appraisal and Surgical Strategy in 18 Cases

Persistent and recurrent hyperparathyroidism

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