Radioguided parathyroidectomy in patients with secondary hyperparathyroidism due to chronic renal failure

Chen, Jun; Wang, Jiadong

doi:10.1097/mnm.0000000000000062

Cited by 16 publications

(6 citation statements)

References 27 publications

(41 reference statements)

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“…The use of injecting Technetium 99-m as a radioisotope to help localize and confirm hyperfunctioning parathyroid tissue has become a popularly used intraoperative adjunct in PTX for PHPT as described in the AAES guidelines for PHPT 1. Use of the Technetium 99-m and the radioguidance probe can facilitate identification of hyperfunctioning parathyroid glands including those in ectopic locations and has been shown to decrease overall operative time 384–386. Use of the “>20% ex vivo count” rule also identifies both hyperplastic and adenomatous parathyroid glands with high sensitivity, and has been suggested as a reliable substitute for frozen section analysis 337,366,387…”

Section: Other Intraoperative Adjuncts and Nonsurgical Approachesmentioning

confidence: 99%

The American Association of Endocrine Surgeons Guidelines for the Definitive Surgical Management of Secondary and Tertiary Renal Hyperparathyroidism

Dream

Kuo

et al. 2022

Annals of Surgery

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Objective: To develop evidence-based recommendations for safe, effective, and appropriate treatment of secondary (SHPT) and tertiary (THPT) renal hyperparathyroidism. Background: Hyperparathyroidism is common among patients with chronic kidney disease, end-stage kidney disease, and kidney transplant. The surgical management of SHPT and THPT is nuanced and requires a multidisciplinary approach. There are currently no clinical practice guidelines that address the surgical treatment of SHPT and THPT. Methods: Medical literature was reviewed from January 1, 1985 to present January 1, 2021 by a panel of 10 experts in SHPT and THPT. Recommendations using the best available evidence was constructed. The American College of Physicians grading system was used to determine levels of evidence. Recommendations were discussed to consensus. The American Association of Endocrine Surgeons membership reviewed and commented on preliminary drafts of the content. Results: These clinical guidelines present the epidemiology and pathophysiology of SHPT and THPT and provide recommendations for work-up and management of SHPT and THPT for all involved clinicians. It outlines the preoperative, intraoperative, and postoperative management of SHPT and THPT, as well as related definitions, operative techniques, morbidity, and outcomes. Specific topics include Pathogenesis and Epidemiology, Initial Evaluation, Imaging, Preoperative and Perioperative Care, Surgical Planning and Parathyroidectomy, Adjuncts and Approaches, Outcomes, and Reoperation. Conclusions: Evidence-based guidelines were created to assist clinicians in the optimal management of secondary and tertiary renal hyperparathyroidism.

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Section: Other Intraoperative Adjuncts and Nonsurgical Approachesmentioning

confidence: 99%

The American Association of Endocrine Surgeons Guidelines for the Definitive Surgical Management of Secondary and Tertiary Renal Hyperparathyroidism

Dream

Kuo

et al. 2022

Annals of Surgery

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“…In recent years, parathyroid surgery has undergone a great evolution with the use of minimally invasive techniques and heat-sealing devices [ 15 , 16 ]. However, surgery is still thought to be associated with more complications than oral medication.…”

Section: Introductionmentioning

confidence: 99%

Safety and efficacy of subtotal or total parathyroidectomy for patients with secondary or tertiary hyperparathyroidism in four academic centers in the Netherlands

Plas

Dulfer

Koh

et al. 2018

Langenbecks Arch Surg

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PurposeHyperparathyroidism (HPT) is a common abnormality in patients with end-stage renal disease (ESRD). Since the introduction of cinacalcet in 2004, a shift from surgery toward predominantly medical treatment has occurred. Surgery is thought to be associated with more complications than oral medication. The aim of this retrospective study was to evaluate 30-day outcomes and effectiveness of parathyroidectomy (PTx) in ESRD patients in the Netherlands.MethodsA national database containing data from four academic medical centers in the Netherlands of patients with ESRD-related HPT, who had undergone PTx and kidney transplantation between 1994 and 2015, was established. Primary endpoints were 30-day mortality and complication rate. Secondary endpoints were biochemical measurements.ResultsWe identified 187 HPT patients undergoing PTx, with a median age of 46 years. Median preoperative PTH level was 866 pg/mL (interquartile range [IQR] 407–1547 pg/mL). At 3 months, the median PTH drop from baseline was 93% (IQR, 71–98%) to a median of 61 pg/mL (IQR, 23–148 pg/mL, p < 0.001). Over the 25-year inclusion period, 13 patients (7.0%) required re-exploration for persistent or recurrent disease. Thirty-day mortality and complication rate were 0.0% and 7.9% respectively. Median serum calcium levels improved significantly postoperatively from 2.6 (2.4–2.8) mmol/L to 2.3 (2.1–2.5) mmol/L (p < 0.001).ConclusionsPTx is a safe and effective procedure in the frail ESRD population. These data show that there should be no reluctance for surgical intervention and when indicated, nephrologists can safely refer these patients for PTx.

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“…However, in studies of parathyroid hyperplasia secondary to chronic renal disease, RNP use was shown to retain its utility and improve the success of surgery. 15, 16 We believe RNP should behave similarly for parathyroid hyperplasia in pHPT. In a study of 845 patients treated with focused parathyroidectomy guided by IOPTH monitoring, the authors concluded that it was the inability of the surgeon to find the abnormal parathyroid gland (rather than missed MGD) that led to operative failure.…”

Section: Discussionmentioning

confidence: 88%

The utility of the radionuclide probe in parathyroidectomy for primary hyperparathyroidism

Jinih

et al. 2017

annals

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INTRODUCTION Parathyroidectomy is the definitive treatment for primary hyperparathyroidism but the intraoperative identification of adenomas is challenging. The aim of this study was to evaluate the utility of a radionuclide probe (RNP) in addition to intraoperative parathyroid hormone ( IOPTH) measurement as an intraoperative diagnostic adjunct in patients undergoing parathyroidectomy for primary hyperparathyroidism. METHODS This was a retrospective cohort study of patients treated between 2004 and 2015 in a university affiliated teaching hospital. Patients were grouped into those with RNP use (RNP+) and those without (RNP-). The primary outcome measure was rate of operative failure, which included false positives. The diagnostic sensitivity and positive predictive value of both RNP and IOPTH were also evaluated. RESULTS A total of 298 patients were included in the study, 127 (42.6%) being in the RNP+ group and 171 (57.4%) in the RNP-group. The false positive rate for the RNP+ patients was 1.6% compared with 9.4% for RNP-patients (p=0.006, hazard ratio [HR]: 6.45). The rates of operative failure were 6.3% and 11.7% respectively (p=0.159, HR: 1.97). RNP use had a sensitivity of 92.0% and a positive predictive value of 98.3% compared with 78.6% and 95.2% respectively for IOPTH monitoring. CONCLUSIONS RNP use is associated with fewer false positives and reduced operative failure than IOPTH measurement. It also has a higher sensitivity and positive predictive value. RNP use is recommended in centres that have the required facilities.

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Radioguided parathyroidectomy in patients with secondary hyperparathyroidism due to chronic renal failure

Abstract: Radioguided localization of the parathyroid glands improves the success rate of surgery in patients with CRF undergoing parathyroidectomy for sHPT.

Cited by 16 publications

References 27 publications

The American Association of Endocrine Surgeons Guidelines for the Definitive Surgical Management of Secondary and Tertiary Renal Hyperparathyroidism

The American Association of Endocrine Surgeons Guidelines for the Definitive Surgical Management of Secondary and Tertiary Renal Hyperparathyroidism

Safety and efficacy of subtotal or total parathyroidectomy for patients with secondary or tertiary hyperparathyroidism in four academic centers in the Netherlands

The utility of the radionuclide probe in parathyroidectomy for primary hyperparathyroidism

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