Surgical management of primary hyperparathyroidism in the era of focused parathyroidectomy: A study in tertiary referral centre of North India

Abstract

Background:Despite the benefits of focused parathyroidectomy (FPTx), few studies have questioned its durability with lower long-term cure rates than bilateral or conventional parathyroidectomy (CPTx). The objective of this study is to bring out the information on the type of surgical management versus cure rate, recurrence, and role of intra-operative parathyroid hormone (IOPTH) level monitoring of PHPT patients.Material and Methods:This was a retrospective study of all PHPT patients treated at our center based on operative approach (CPTx vs FPTx) or use of IOPTH. Treatment failure was divided into persistent or recurrent disease, based on documentation of hypercalcemia in combination with an inappropriate PTH within 6 months or more of surgery, respectively.Results:Overall, 50.78% patients underwent CPTx and 49.32% FPTx. 29 FPTx were converted to CPTx. Intention to treat analysis between CPTx and FPTx showed that the persistence rate was not statistically different at 2.54% and 4%, respectively (P = 0.98). Furthermore, when the persistence rate was scrutinized by a treatment received (TR) instead of ITT analysis, the persistence rate was higher for the patients who underwent TR-CPTX than for the patients subjected to TR-FPTX (3.22% vs 1.08%) but not significant statistically. We further analyzed the outcome of FPTx with IOPTH (n = 213) and FPTx without IOPTH (n = 28). The outcome did not differ between two groups statistically.Conclusion:FPTx yields a similar success rate as compared to CPTx even in symptomatic PHPT patients and can be performed safely even without intra-opeartive adjunct IOPTH in selected patients.

Comment on “Risk Factors of Redo Surgery After Unilateral Focused Parathyroidectomy – Conclusions From a Comprehensive Nationwide Database of 13,247 Interventions Over 6 Years”

“…Use of intraoperative adjuncts such as intraoperative PTH monitoring, and frozen section histology can help achieve surgical cure in a certain proportion of patients undergoing parathyroidectomy 4 . Was the role of any intraoperative adjuncts studied in the current study, and if so, were these adjuncts predictive of failure of Parathyroidectomy and need for redo surgery after focused parathyroidectomy.…”