Outcomes of Total Parathyroidectomy with Autotransplantation versus Subtotal Parathyroidectomy Techniques for Secondary Hyperparathyroidism in Chronic Renal Failure

Sarı, Ramazan; Yabanoğlu, Hakan; Hargura, Abdirahman Sakulen; Kus, Murat M.; Arer, İlker Murat

doi:10.29271/jcpsp.2020.01.18

Cited by 7 publications

(6 citation statements)

References 17 publications

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“…The preoperative diagnosis was based on criteria of the KDIGO 2009 clinical practice guideline. TPTX with/without auto-transplantation of parathyroid tissue and SPTX are currently considered as standard surgical procedures in the treatment of SHPT [ 20 , 21 ]. Previous studies have noted that the TPTX without auto-transplantation approach has been associated with lower rates of recurrence [ 22 ].…”

Section: Perioperative Management and Surgical Proceduresmentioning

confidence: 99%

Risk Factor Analysis and Prediction of Severe Hypocalcemia after Total Parathyroidectomy without Auto-Transplantation in Patients with Secondary Hyperparathyroidism

Zhang

et al. 2023

International Journal of Endocrinology

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Objective. Our study aimed to develop and validate a nomogram to predict severe hypocalcemia (SH) before total parathyroidectomy (TPTX) without auto-transplantation in patients with secondary hyperparathyroidism. Methods. A total of 299 consecutive patients who underwent TPTX without transplantation for secondary hyperparathyroidism were selected from the General Hospital of Northern Theater Command between January 2013 and December 2021. Of these, patients who underwent surgery between January 2013 and December 2020 formed the training cohort (n = 208) to develop a nomogram, and those who underwent surgery thereafter formed the validation cohort (n = 91) to validate the performance of this nomogram. Univariate and multivariate logistic regression analyses were used to identify the risk factors associated with SH, and then, a nomogram was constructed. Results. The incidence of postoperative SH was 27.9% and 35.2% in the training and validation cohorts, respectively. The preoperative factors associated with SH were younger age, lower serum calcium (Ca) level, higher intact parathyroid hormone (iPTH) level, and higher serum alkaline phosphatase (ALP) level. Incorporating these 4 factors, the nomogram achieved good concordance indexes of 0.866 (95%CI, 0.816–0.916) and 0.867 (95% CI, 0.793–0.941) in predicting SH in the training and validation cohorts, respectively, and had well-fitted calibration curves. The positive predictive values of the nomogram were 64.7% (54.1%–78.4%) and 75.0% (58.6%–88.5%), and negative predictive values of the nomogram were 90.0% (82.9%–93.6%) and 86.4% (73.5%–94.0%) for the training and validation cohorts, respectively. Conclusions. We developed and validated a nomogram for the prediction of SH in patients who underwent TPTX without auto-transplantation for secondary hyperparathyroidism. Our nomogram may facilitate the identification of high-risk SH in patients after TPTX and optimization of preoperative decision-making.

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Section: Perioperative Management and Surgical Proceduresmentioning

confidence: 99%

Risk Factor Analysis and Prediction of Severe Hypocalcemia after Total Parathyroidectomy without Auto-Transplantation in Patients with Secondary Hyperparathyroidism

Zhang

et al. 2023

International Journal of Endocrinology

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“…This procedure avoids postoperative hypocalcemia, is more effective at improving quality of life than PTX alone, and the iPTH level is not affected by the quantity and quality of graft fragments ( 43 )( Table 1 ). However, a limitation of this procedure is that autologous parathyroid transplantation may lead to HPT recurrence ( 52 ), but the persistence and recurrence probability of HPT are much less than sPTX ( 41 , 42 )( Table 1 ). Thus, some experts recommend tPTX-AT as the preferred surgical management method for SHPT, because reoperation at the forearm autograft site is simpler than in the neck after sPTX ( 43 ).…”

Section: Treatment For Hptmentioning

confidence: 99%

Advances in the treatment of secondary and tertiary hyperparathyroidism

et al. 2022

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Secondary hyperparathyroidism (SHPT) and tertiary hyperparathyroidism (THPT) are common and complicated clinical endocrine diseases. The parathyroid glands maintain endocrine homeostasis by secreting parathyroid hormone to regulate blood calcium levels. However, structural alterations to multiple organs and systems occur throughout the body due to hyperactivity disorder in SHPT and THPT. This not only decreases the patients’ quality of life, but also affects mortality. Since current treatments for these diseases remains unclear, we aimed to develop a comprehensive review of advances in the treatment of SHPT and THPT according to the latest relevant researches.

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“…Among the various factors that trigger this disease, SHPT due to chronic renal failure (CRF) is the most common and is an important factor affecting the quality of survival of patients with CRF ( 3 ). Medical drug therapy and hemodialysis are currently the main treatment methods for CRF-SHPT patients, but about 50% of them still cannot relieve the clinical symptoms of SHPT after medical drugs or hemodialysis, and can gradually progress to refractory or progressive disease, at which point the patient will require surgical treatment ( 4 , 5 ). However, these patients undoubtedly increase the risk of surgery due to long-term hemodialysis and combined multisystemic pathologies, such as impaired coagulation mechanisms, hypoproteinemia, and renal anemia ( 6 ).…”

Section: Prefacementioning

confidence: 99%

Effect of High-Quality Whole-Course Care on Psychological Status and Postoperative Pharyngeal Complications in Patients Undergoing Surgery for Hyperparathyroidism Secondary to Chronic Rrenal Failure

Luo

Zheng

2022

Front. Surg.

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ObjectiveTo observe the effects of high-quality whole-course care on the psychological status and postoperative pharyngeal complications in patients undergoing surgery for secondary hyperparathyroidism (SHPT) to chronic rrenal failure (CRF).MethodsThe clinical data of 62 patients who underwent surgical treatment for CRF-SHPT from April 2018 to October 2021 in our department were retrospectively analyzed. According to the different nursing methods after admission, they were divided into two groups, of which 33 patients who received high-quality whole-course care were the high-quality group, and 29 patients who received routine nursing were the regular group. Compliance, occurrence of pharyngeal complications, improvement of preoperative and postoperative psychological status [Assessed by self-rating anxiety scale (SAS) and self-rating depression scale (SDS)], nursing satisfaction scores, and serum hormone levels [intact parathyroid hormone (iPTH), calcium (Ca), Phosphorus (P)] were compared between the two groups.ResultsThe differences between the general conditions and clinical characteristics of the two groups were not significant (p > 0.05). After care, the number of cases with good compliance in the high-quality group was higher than that in the regular group, and the number of cases with non-compliance was lower than that in the regular group (p < 0.05); the difference in the number of cases with partial compliance after care between the two groups was not significant (p > 0.05). There was no significant difference in the incidence of pharyngeal complications such as sore throat, nausea and vomiting, dry throat and hoarseness between the two groups (p > 0.05); however, the 24-h postoperative sore throat and dry throat scores in the high-quality group were significantly lower than those in the regular group (p < 0.05). Patients in the high-quality group had higher nursing attitude, nursing skills, nursing safety, nursing quality, and overall nursing satisfaction scores than the regular group (p < 0.05). Compared with the pre-care period, SAS and SDS scores decreased in both groups after care, and SAS and SDS scores decreased more in the high-quality group than in the regular group (p < 0.05). Serum iPTH, Ca, and P levels decreased in both groups at 1 week after surgery, and iPTH, Ca, and P levels decreased more in the high-quality group than in the regular group (p < 0.05).ConclusionThrough the high-quality whole-course care, full informed participation and active cooperation of CRF-SHPT patients, close medical and nursing collaboration, attention to detail and overall level of treatment can effectively improve patient compliance, psychological status and postoperative serum indicators, promote patient recovery and improve nursing satisfaction.

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Outcomes of Total Parathyroidectomy with Autotransplantation versus Subtotal Parathyroidectomy Techniques for Secondary Hyperparathyroidism in Chronic Renal Failure

Abstract: Objective: To compare the safety and the effectiveness of total parathyroidectomy with autotransplantation versus subtotal parathyroidectomy for refractory secondary hyperparathyroidism in patients with chronic kidney disease. Study Design: A comparative study.

Cited by 7 publications

References 17 publications

Risk Factor Analysis and Prediction of Severe Hypocalcemia after Total Parathyroidectomy without Auto-Transplantation in Patients with Secondary Hyperparathyroidism

Risk Factor Analysis and Prediction of Severe Hypocalcemia after Total Parathyroidectomy without Auto-Transplantation in Patients with Secondary Hyperparathyroidism

Advances in the treatment of secondary and tertiary hyperparathyroidism

Effect of High-Quality Whole-Course Care on Psychological Status and Postoperative Pharyngeal Complications in Patients Undergoing Surgery for Hyperparathyroidism Secondary to Chronic Rrenal Failure

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