Total parathyroidectomy without autotransplantation as a standard procedure in the treatment of secondary hyperparathyroidism

Ockert, S.; Willeke, Frank; Richter, Α.; Jonescheit, J; Schnuelle, Peter; Woude, Fokko van der; Post, Stefan

doi:10.1007/s00423-002-0307-9

Cited by 65 publications

(97 citation statements)

References 27 publications

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“…The clinical significance of supernumerary glands and parathyroid cell rests detached from parathyroid glands is underscored by the fact that the majority of patients after TPTX and even after TPTX+BCT have measurable PTH levels after surgery [57,64,65] (EL 3). Thus, routine bilateral cervical thymectomy (BCT) is a continuous matter of debate in patients undergoing surgery for renal HPT.…”

Section: (El 3)mentioning

confidence: 99%

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: 99%

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

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“…They state that the absence of PTH has no signifi cant clinical consequence on bone of patients who undergo hemodialysis and who are treated with calcium and cholecalciferol supplements. These conclusions are, however, questioned by other investigators [3]. The ideal blood concentration of intact PTH is not known for uremic subjects, but the levels advocated by different researchers varied from 75 to 175 pg/ml.…”

Section: Discussionmentioning

confidence: 97%

“…As chronic renal failure persists after the operation, this glandular tissue is continually stimulated, and hyperparathyroidism may recur [16]. Some researchers presently advocate total parathyroidectomy without grafting, thus avoiding these recurrences in patients non-candidates for renal transplantation [3]. They state that the absence of PTH has no signifi cant clinical consequence on bone of patients who undergo hemodialysis and who are treated with calcium and cholecalciferol supplements.…”

Section: Discussionmentioning

confidence: 99%

“…José Antonio Amondarain . Fernando Vidaur abdominal [6] or pre-sternal [7] and TPT without transplantation advocated by some authors for dialysis patients non candidates for renal transplantation [3,8].…”

Section: Original Articlementioning

confidence: 99%

“…Several techniques are employed currently in the management of secondary hyperparathyroidism following renal failure (SHP) since the proposals of Wells et al [1]: Subtotal Parathyroidectomy (STPT) [2], Total Parathyroidectomy (TPT) [3], TPT with cervical auto-transplantation, TPT with muscular ante-brachial auto-transplantation [4], TPT with subcutaneous auto-transplantation : ante-brachial [5],…”

Section: Introductionmentioning

confidence: 99%

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The pattern of the descent of PTH measured by intraoperative monitoring of intact-PTH in surgery for renal hyperparathyroidism

Echenique-Elizondo

Díaz-Aguirregoitia

Amondarain³

et al. 2008

Indian J Surg

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Background In the setting of total parathyroidectomy and autotransplantation surgery (TPTxAS) treatment for secondary hyperparathyroidism (SHPT) we evaluated whether intraoperative parathyroid hormone (iPTH) monitoring is an useful tool as a reference for total parathyroid removal.Design Prospective open single value measurement effi cacy study of one intraoperative (i.o.) diagnostic monitoring method (iPTH ) on a cohort of surgical patients. Main outcome measures Serum levels of iPTH during surgery and prediction time of the of descent of PTH levels (measured in the clinic, at admission day and intra-operatively during induction of anesthesia, and every 5 and 10 minutes after removal of adenoma and 24 hours thereafter) were analyzed. PatientsResults iPTH levels dropped clearly at ten minutes in all 35 patients and were non-measurable at 24 hours. iPTH decreased from pathological (1302.24 + 424.9 pg/ml) to half (50%) the values at the third intra-operative determination -minute 10 - (614.8 ± 196.62) and was undetectable at 24 hours.Conclusions Intra-operative measurement of iPTH is useful in the prediction of complete removal of all parathyroid tissue prior to autotransplantation thus avoiding persistence because of incomplete surgery.

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Parathyroid Graft Function After Presternal Subcutaneous Autotransplantation for Renal Hyperparathyroidism

Echenique-Elizondo¹

2006

Arch Surg

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Presternal subcutaneous autotransplantation of parathyroid tissue after total parathyroidectomy for renal hyperparathyroidism could be at least as effective as intramuscular grafting, without its complications. Design: Prospective study of a postoperative diagnostic method of monitoring intact parathyroid hormone (iPTH) levels among a cohort of surgical patients, without loss to follow-up. Setting: Hemodialysis unit in a university hospital. Patients: Twenty-five patients (17 women and 8 men) underwent total parathyroidectomy and presternal subcutaneous autotransplantation for renal

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Total parathyroidectomy without autotransplantation as a standard procedure in the treatment of secondary hyperparathyroidism

Cited by 65 publications

References 27 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

The pattern of the descent of PTH measured by intraoperative monitoring of intact-PTH in surgery for renal hyperparathyroidism

Parathyroid Graft Function After Presternal Subcutaneous Autotransplantation for Renal Hyperparathyroidism

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