Parathyroidectomy in secondary hyperparathyroidism: Is there an optimal operative management?

Richards, Melanie L.; Wormuth, Jennifer; Bingener, Juliane; Sirinek, Kenneth R.

doi:10.1016/j.surg.2005.08.036

Cited by 99 publications

(99 citation statements)

References 52 publications

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“…Both ectopic and supernumerary IPGs were found in two patients (7.4 %). Based on this very recent study and a previous systematic review [40], it may be postulated that routine complete BCT is essential during subtotal PTX and TPTX+AT, especially if fewer than four glands were identified in typical position to avoid recurrence/persistence of renal HPT (EL 3; rec B). Because of the low frequency of supernumerary IPGs and a suspected low-proliferation stimulus, the relevance of BCT after resection of four glands in predialytic patients and those after successful kidney transplantation has to be questioned [41,42] (Table 5).…”

Section: (El 3)mentioning

confidence: 95%

“…The interpretation of these data remains difficult as outcomes also rely on the quality of the initial operation, independent of the approach being PTX or TPTX+AT. A recent systematic review of 53 publications on reoperations for recurrent or persistent renal HPT identified 501 patients who had either subtotal PTX (36 %) or TPTX+AT (64 %) as initial operation [40] (EL 2). Reoperation determined that inadequate cervical explorations occurred in 42 % of patients who had undergone subtotal PTX and in 34 % of patients who had undergone TPTX+AT.…”

Section: Surgical Concepts In Renal Hyperparathyroidismmentioning

confidence: 99%

“…Reoperations for persistent or recurrent renal HPT in the neck are challenging due to scar formation aggravating identification of parathyroid glands and meticulous preparation and since they are related to a higher rate of recurrent laryngeal nerve palsy (RLNP, 2 to 10 %) [40,60]. Thus, there are several important aspects to consider.…”

Section: Surgical Approach For Persistent and Recurrent Renal Hyperpamentioning

confidence: 99%

“…A detailed meta-analysis comprising the pre-cinacalcet era ) scrutinized 53 publications with 501 patients reoperated for recurrent or persistent renal HPT. Inadequate prior exploration was the main cause of operative failures for both procedures, subtotal PTX (42.5 %) and total PTX+AT (34 %) [40] (EL 2) ( Table 1).…”

Section: Concerns Regarding Permanent Postoperative Hypoparathyroidismentioning

confidence: 99%

“…Despite better understanding of the pathophysiologic mechanisms of renal HPT and efforts to standardize management of patients with renal HPT [40], controversial opinions regarding different treatment options and their effectiveness prevail [107]. The two main problems are the variations of follow-up 5 of patients suffering from renal HPT either before or after renal transplantation and the management of the treatment with medical and surgical strategies.…”

Section: Timing Of Parathyroid Surgery Prior To Renal Transplantationmentioning

confidence: 99%

See 4 more Smart Citations

Surgical management of secondary hyperparathyroidism in chronic kidney disease—a consensus report of the European Society of Endocrine Surgeons

Lorenz

Bartsch

Sancho

et al. 2015

Langenbecks Arch Surg

104

130

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Background Despite advances in the medical management of secondary hyperparathyroidism due to chronic renal failure and dialysis (renal hyperparathyroidism), parathyroid surgery remains an important treatment option in the spectrum of the disease. Patients with severe and complicated renal hyperparathyroidism (HPT), refractory or intolerant to medical therapy and patients with specific requirements in prospect of or excluded from renal transplantation may require parathyroidectomy for renal hyperparathyroidism. Methods Present standard and actual controversial issues regarding surgical treatment of patients with hyperparathyroidism due to chronic renal failure were identified, and pertinent literature was searched and reviewed. Whenever applicable, evaluation of the level of evidence concerning diagnosis and management of renal hyperparathyroidism according to standard criteria and recommendation grading were employed. Results were discussed at the 6th Workshop of the European Society of Endocrine Surgeons entitled Hyperparathyroidism due to multiple gland disease: An evidence-based perspective.Results Presently, literature reveals scant data, especially, no prospective randomized studies to provide sufficient levels of evidence to substantiate recommendations for surgery in renal hyperparathyroidism. Appropriate surgical management of renal hyperparathyroidism involves standard bilateral exploration with bilateral cervical thymectomy and a spectrum of four standardized types of parathyroid resection that reveal comparable outcome results with regard to levels of evidence and recommendation. Specific patient requirements may favour one over the other procedure according to individualized demands. Conclusions Surgery for patients with renal hyperparathyroidism in the era of calcimimetics continues to play an important role in selected patients and achieves efficient control of hyperparathyroidism. The overall success rate and longterm control of renal hyperparathyroidism and optimal handling of postoperative metabolic effects also depend on the timely indication, individually suitable type of parathyroid resection and specialized endocrine surgery.

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Section: (El 3)mentioning

confidence: 95%

Section: Surgical Concepts In Renal Hyperparathyroidismmentioning

confidence: 99%

Section: Surgical Approach For Persistent and Recurrent Renal Hyperpamentioning

confidence: 99%

Section: Concerns Regarding Permanent Postoperative Hypoparathyroidismentioning

confidence: 99%

Section: Timing Of Parathyroid Surgery Prior To Renal Transplantationmentioning

confidence: 99%

See 3 more Smart Citations

Surgical management of secondary hyperparathyroidism in chronic kidney disease—a consensus report of the European Society of Endocrine Surgeons

Lorenz

Bartsch

Sancho

et al. 2015

Langenbecks Arch Surg

104

130

View full text Add to dashboard Cite

show abstract

Fine‐needle aspiration of a parathyroid hyperplasia with unusual clinical and cytologic presentation

Ren

Gong

2007

Diagnostic Cytopathology

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Pedicled parathyroid gland autotransposition in secondary and tertiary hyperparathyroidism

2014

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Parathyroidectomy in secondary hyperparathyroidism: Is there an optimal operative management?

Cited by 99 publications

References 52 publications

Surgical management of secondary hyperparathyroidism in chronic kidney disease—a consensus report of the European Society of Endocrine Surgeons

Surgical management of secondary hyperparathyroidism in chronic kidney disease—a consensus report of the European Society of Endocrine Surgeons

Fine‐needle aspiration of a parathyroid hyperplasia with unusual clinical and cytologic presentation

Pedicled parathyroid gland autotransposition in secondary and tertiary hyperparathyroidism

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