Parathyroid re-exploration

Shaha, Ashok R.

doi:10.1016/j.otc.2004.02.013

Cited by 8 publications

(8 citation statements)

References 30 publications

(28 reference statements)

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“…This knowledge is invaluable in situations where pre-operative localization has failed or in reoperative parathyroid surgery. 6 …”

Section: Surgical Anatomymentioning

confidence: 99%

“…Patients with persistent or recurrent hyperparathyroidism after previous surgery are difficult to treat. 6 The best strategy is to prevent the need for re-operative surgery in the first instance. Notwithstanding the technical difficulties in dealing with a hostile neck, the surgeon has to contend with a frustrated patient with high expectations of success.…”

Section: Parathyroid Re-explorationmentioning

confidence: 99%

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Current concepts in the management of primary hyperparathyroidism

Iyer

Shaha

2010

Indian J Surg Oncol

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Primary hyperparathyroidism is the commonest cause of hypercalcemia in the ambulatory setting. Widespread use of routine laboratory screening has resulted in a large number of patients presenting with subclinical disease. In truly asymptomatic patients, consensus guidelines have been developed to determine which patients need definitive treatment. The most common pathologic finding is parathyroid adenoma, followed by hyperplasia, double adenomas and parathyroid carcinoma. The mainstay of treatment is surgery. While there is still an important role for four gland exploration and evaluation, there is now considerable interest in a more focused surgical approach. This paradigm shift is based on localizing studies that combine sestamibi scanning with anatomic imaging, most commonly ultrasound scanning. A range of minimally invasive approaches have been developed to treat parathyroid adenomas, including unilateral and single gland explorations as well as a number of different endoscopic techniques. Intra-operative rapid parathormone assay has replaced histologic examination as a more effective method to confirm the adequacy of surgery in most cases. Functional localization and exploration using a gamma probe has also been described. The management of patients with persistent or recurrent hyperparathyroidism is difficult and requires a multidisciplinary approach.

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“…This knowledge is invaluable in situations where pre-operative localization has failed or in reoperative parathyroid surgery. 6 …”

Section: Surgical Anatomymentioning

confidence: 99%

Section: Parathyroid Re-explorationmentioning

confidence: 99%

Current concepts in the management of primary hyperparathyroidism

Iyer

Shaha

2010

Indian J Surg Oncol

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“…The most common ectopic location of the inferior parathyroid gland is within the thymic capsule or the superior mediastinum. Even though there are typically 4 parathyroid glands, approximately 10% of individuals have between 5 and 7 glands, known as supernumerary parathyroid glands, and 2%–3% of individuals have fewer than 4 glands (6). …”

Section: Anatomymentioning

confidence: 99%

“…Frozen section sampling can also be helpful for comparing an abnormal gland with a normal parathyroid. The 4-gland exploration approach has a high success rate, on the order of 95% (3,6). …”

Section: Treatmentmentioning

confidence: 99%

“…To provide successful care for patients with primary hyperparathyroidism and especially those for whom 1 surgical treatment has failed, it is necessary to have a team of physicians who understand this disease and work together, including an endocrinologist, a parathyroid surgeon, a nuclear medicine physician, anatomic radiologists, and clinical/laboratory pathologists (Fig. 4) (6). …”

Section: Recurrent Hyperparathyroidismmentioning

confidence: 99%

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Nuclear Imaging and Minimally Invasive Surgery in the Management of Hyperparathyroidism

Judson

Shaha²

2008

J Nucl Med

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Primary hyperparathyroidism is the most common cause of hypercalcemia, and the treatment is primarily surgical. Because of biochemical screening, more patients now present with asymptomatic primary hyperparathyroidism, and consensus guidelines have been developed for the treatment of these patients. There is now considerable interest in minimally invasive approaches to the treatment of hyperparathyroidism. Sestamibi scanning as a localizing study, used in combination with anatomic imaging and intraoperative rapid parathyroid hormone assays, has enabled focused surgical approaches. Patients with localizing studies that indicate a single parathyroid adenoma are candidates for such approaches, including unilateral neck exploration, minimally invasive single-gland exploration, or endoscopic exploration instead of the traditional approach of bilateral neck exploration. Nuclear imaging is also critical to the successful management of patients with persistent or recurrent hyperparathyroidism.

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Impact of Localization Studies and Clinical Scenario in Patients With Hyperparathyroidism Being Evaluated for Reoperative Neck Surgery

et al. 2011

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Background: Previous studies have focused on the success of localization studies (LSs) in patients undergoing reoperative parathyroid surgery; however, patients who did not undergo reexploration surgery have been excluded from analysis. In addition, the concept of whether clinical scenario (CS) suggests single-vs multiple-gland disease in reoperative strategy is often underemphasized. Objective: To evaluate how LSs and CS direct operative strategy in patients being considered for reexploration. Design: Retrospective review of a prospective database. Setting: Tertiary referral center. Patients: Two hundred three patients with hyperparathyroidism who underwent previous neck surgery. The CS stratified patients as candidates for single-or multiplesite exploration (or unknown). Main Outcome Measure: Ability of CS and LSs to direct successful reexploration. Results: Of 203 patients, 27 were not explored owing to nonlocalizing studies. Of the remaining 176 patients, LSs accurately guided reexploration in 85%. However, when including the 27 nonexplored patients, the success of LSs decreased to 73%. The cure rate in reoperated patients was 96% but was reduced to 83% when including nonexplored patients. Of the reoperated patients, 83% had single-site disease and 17% had multiple-site disease. The positive predictive value of LSs in predicting single-or multiple-site disease was 92% and 73%, respectively. However, when stratified by CS, the positive predictive value increased to 95% for single-site disease and to 100% for multiple-site disease. Conclusions: Failure to cure patients was 4 times more likely to be due to nonlocalizing studies than to a failed reexploration. Stratification by CS was useful in the interpretation of LSs and in determining the most accurate reoperative approach.

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Parathyroid re-exploration

Cited by 8 publications

References 30 publications

Current concepts in the management of primary hyperparathyroidism

Current concepts in the management of primary hyperparathyroidism

Nuclear Imaging and Minimally Invasive Surgery in the Management of Hyperparathyroidism

Impact of Localization Studies and Clinical Scenario in Patients With Hyperparathyroidism Being Evaluated for Reoperative Neck Surgery

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