Thermal ablation versus parathyroidectomy for secondary hyperparathyroidism: A meta-analysis

Purpose: The present systematic review and meta-analysis was designed to evaluate the efficacy and safety of microwave ablation (MWA) treatment for secondary hyperparathyroidism (SHPT). Materials and methods: The study authors systematically searched the Web of Science, Cochrane Library, PubMed, Embase and Ovid databases for studies published in English prior to 7October 2019. All studies included in the meta-analysis measured levels of parathyroid hormone (PTH), calcium and phosphorus, and included data related to complications following MWA treatment for SHPT. Results: The meta-analysis ultimately included 233 patients from two retrospective cohort studies and six retrospective self-control studies. Compared to PTH level measurements obtained after MWA, measurements obtained at one day (weighted mean differences (WMD): 890.314, 95% confidence interval (CI): 767.121-1013.506, p < 0.01) , one week (WMD: 860.298, 95% CI: 759.401-961.194, p < 0.01), one month (WMD: 800.846, 95% CI: 687.709-913.983, p < 0.01) and six months (WMD: 860.847, 95% CI: 745.214-976.480, p < 0.01) after MWA were significantly lower. Calcium and phosphorus levels at one day and one week after MWA were also significantly lower than those measured before MWA. After MWA, the incidence of nerve injury was 1.2% (3/233; effect size (ES): 0.022, 95% CI: À0.003-0.048, p < 0.01). After MWA, the incidence of hypocalcemia was 15.8% (37/233; ES: 0.449, 95% CI: 0.341-0.556, p < 0.01). Conclusion: The preliminary results of this meta-analysis indicate that MWA may be effective and safe in treating patients with SHPT, and that future prospective research and randomized controlled trials (RCT) are necessary.

Section: Discussioncontrasting

confidence: 72%

Efficacy and safety of microwave ablation treatment for secondary hyperparathyroidism: systematic review and meta-analysis

Cao

Zhao

Wei

et al. 2020

“…However, the sample size in this study was relatively small and the conclusion should be further verified in RCTs and meta-analysis with larger sample size. Comparison between thermal ablation and parathyroidectomy for secondary hyperparathyroidism (SHPT) had been summarized in a recent meta-analysis [53]. It came to a conclusion that thermal ablation reduced the risk of hypocalcemia but increased the risk of SHPT persistence or recurrence compared with parathyroidectomy.…”

Section: Discussionmentioning

confidence: 99%

Efficacy and safety of US-guided thermal ablation for primary hyperparathyroidism: a systematic review and meta-analysis

Huang

et al. 2020

Purpose: To summarize the published literature on thermal ablation for primary hyperparathyroidism (PHPT) and to evaluate the effectiveness and safety of thermal ablation as a novel treatment strategy. Materials and methods: Two authors carried out the literature search using four databases independently, including PubMed, Embase, Cochrane, and Web of Science. The meta-analysis included prospective and retrospective data that compared post-ablative outcomes to pre-ablative values. The primary outcomes were parathyroid hormone (PTH), serum calcium and volume of the parathyroid gland (VPG). Results: From the 184 original articles, five studies (4 retrospective studies and 1 prospective study) examining 84 patients met the inclusion criteria. The meta-analysis showed significant reduction of PTH at 3 (standardized mean difference (SMD) ¼ À1.09, 95% confidence index (CI) ¼ À1.42 to À0.76, p < 0.001) and 6 months (SMD ¼ À1.13, 95% CI ¼ À1.46 to À0.80, p < 0.001) after thermal ablation. Serum calcium level was significantly reduced at 3 (mean difference (MD) ¼ À0.31, 95% CI ¼ À0.50 to À0.12, p ¼ 0.001) and 6 months (MD ¼ À0.31, 95% CI ¼ À0.46 to À0.17, p < 0.001) after thermal ablation. There was no significant difference between pre-ablative VPG and that of 6 months after ablation (MD ¼ À0.30, 95% CI ¼ À0.70 to 0.09, p ¼ 0.13). The most common complications were transient dysphonia and subcutaneous edema. No major complications or death occurred. Conclusion: Thermal ablation is effective and safe for treatment of PHPT. PTH and calcium levels were reduced significantly at 3 and 6 months after thermal ablation.

“…Third, in the present study, eight non-responsive patients in the MWA group underwent PTX during the efficacy evaluation period, which may have affected the response rate. Both MWA and PTX have been used to treat patients with severe secondary hyperparathyroidism [15,21]. PTX is commonly considered to reduce mortality in patients with secondary hyperparathyroidism undergoing hemodialysis [21][22][23][24][25][26].…”

Section: Discussionmentioning

confidence: 99%

“…MWA has advantages over PTX [10], namely minimal invasiveness, ease of administration, and rapid recovery, and MWA has achieved good results in patients with severe secondary hyperparathyroidism [11][12][13]. However, some studies have shown that MWA is less effective than PTX for severe secondary hyperparathyroidism [14,15]. Additionally, most studies have reported only the short-term results of MWA, generally those within 29 months [11,16,17].…”

Section: Introductionmentioning

confidence: 99%

Microwave ablation versus parathyroidectomy for severe secondary hyperparathyroidism in patients on hemodialysis: a retrospective multicenter study

Diao

Qian

Teng

et al. 2021

Background: Microwave ablation is effective for severe secondary hyperparathyroidism, but the difference in efficacy between microwave ablation and parathyroidectomy remains unclear. In this multicenter retrospective cohort study, we compared the long-term clinical efficacy of microwave ablation and parathyroidectomy for severe secondary hyperparathyroidism undergoing hemodialysis. Materials and methods: The patients were divided into microwave ablation and parathyroidectomy groups. The primary endpoint was the proportion of patients with intact parathyroid hormone (iPTH) concentrations within the target range (100-600 pg/mL) during the efficacy assessment phase. The secondary endpoints were (i) differences in iPTH concentrations over time between the two groups, and (ii) decreases in iPTH concentrations over time in the two groups. Results: Microwave ablation was performed in 47/92 patients and parathyroidectomy in 45/92. Primary endpoint: iPTH concentrations within the target range were achieved during the efficacy assessment phase in 26/47 patients (55.3%) and in 14/45 (31.1%) patients in the microwave ablation and parathyroidectomy groups, respectively (p ¼ .02). Secondary endpoints: (i) Mean iPTH concentrations during the efficacy assessment phase were significantly higher in the microwave ablation versus parathyroidectomy groups (649 ± 519 pg/mL versus 136 ± 228 pg/mL, respectively; p < .01). (ii) Mean decrease in iPTH concentration from baseline was 725 ± 605 pg/mL versus 1369 ± 478 pg/mL in the MWA versus parathyroidectomy groups, respectively (p < .01). Conclusions: Ultrasound-guided percutaneous microwave ablation provides higher iPTH target-achieving rates than parathyroidectomy in patients with severe secondary hyperparathyroidism undergoing hemodialysis.