Total Parathyroidectomy Without Autotransplantation for Secondary Hyperparathyroidism

Shih, Ming-Lang; Duh, Quan‐Yang; Hsieh, Chung-Bao; Lin, Shih‐Hua; Wu, Hurng‐Sheng; Chu, Paul-Ling; Chen, Tien‐Yu; Yu, Jyh‐Cherng

doi:10.1007/s00268-008-9765-8

Cited by 50 publications

(65 citation statements)

References 21 publications

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“…The third technique, total parathyroidectomy without autotransplantation (tPtx), was initially severely criticised mainly for the long-term hypoparathyroidism induced and its consequences on bone metabolism [13]. Recent papers, however, have revived tPtx as a trustworthy technique with comparable results in short-and medium-term follow-up [6,14,15].…”

Section: Discussionmentioning

confidence: 99%

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Częściowe usunięcie przytarczyc versus całkowite usunięcie przytarczyc z autoprzeszczepem we wtórnej nadczynności przytarczyc — jednoośrodkowe, prospektywne badanie w grupie 43 pacjentów

Neagoe

Mureşan

Voidăzan

et al. 2016

Endokrynologia Polska

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Introduction: The need for parathyroidectomy remains high in the group of patients on long-term dialysis with medically refractory secondary hyperparathyroidism (sHPT). We aim to compare the results after subtotal parathyroidectomies (sPtx) and total parathyroidectomies with autotransplant (tPtx + AT) performed for sHPT at a single referral centre. Material and methods:This prospective study comparatively analysed sPtx and tPtx + AT performed in our department between February 2010 and December 2014. We followed-up both surgical techniques, with respect to the main clinical symptoms, laboratory data, mortality, and recurrent disease. Results: Forty-three patients on whom we performed 26 sPtx and 19 tPtx + AT were entered in the study. There were no statistically significant differences between groups as far as demographic and preoperative clinical data are concerned. We did not encounter postoperative mortality in either of the groups. The follow-up period was significantly longer for the sPtx group (p = 0.04). The immediate postoperative serum calcium levels were significantly lower in the tPtx + AT group (p = 0.009). Definitive hypoparathyroidism was encountered in two patients in the sPtx group (8.3%) and in one from the tPtx + AT group (5.26%). Four patients from the sPtx group (16.6%) and three from the tPtx + AT group (15.78%) died during the follow-up due to causes unrelated to parathyroidectomy. Overall we had two recurrences in the sPtx group and none in the tPtx + AT group (p = 0.57).

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Section: Discussionmentioning

confidence: 99%

“…It seems that tPtx has reappeared as a "rehabilitated" surgical technique, after a long period of controversial discussion [6,14,16,25,26]. In the studied period we performed tPtx in few cases, generally in patients with severe and long lasting disease and without a realistic perspective of renal transplantation.…”

Section: Prace Oryginalnementioning

confidence: 99%

Częściowe usunięcie przytarczyc versus całkowite usunięcie przytarczyc z autoprzeszczepem we wtórnej nadczynności przytarczyc — jednoośrodkowe, prospektywne badanie w grupie 43 pacjentów

Neagoe

Mureşan

Voidăzan

et al. 2016

Endokrynologia Polska

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“…The third surgical option is total parathyroidectomy without an autoimplant, which has been described and reported to be potentially associated with complications such as adynamic bone disease and hypocalcaemia (4,8). Recently, this technique has gained popularity again, but there is still controversy about its outcomes, and long-term studies are required.…”

mentioning

confidence: 99%

“…term calcium and vitamin D supplementation (4); it is this practice that may result in recurrence because of growth of the parathyroid remnant or the autograft (6). The third surgical option is total parathyroidectomy without an autoimplant, which has been described and reported to be potentially associated with complications such as adynamic bone disease and hypocalcaemia (4,8).…”

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confidence: 99%

Outcomes of Total Parathyroidectomy with Autotransplantation versus Subtotal Parathyroidectomy with Routine Addition of Thymectomy to both Groups: Single Center Experience of Secondary Hyperparathyroidism

Sakman¹,

Parsak²,

Balal³

et al. 2014

Balkan Med J

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Secondary hyperparathyroidism (sHPT) is a common acquired disorder seen in chronic renal failure. It may result in potentially serious complications including metabolic bone diseases, severe atherosclerosis and undesirable cardiovascular events (1). Parathyroidectomy (PTX) is required in about 20% of patients after 3-10 years of dialysis and in up to 40% after 20 years (2, 3).When medical treatment fails, subtotal parathyroidectomy (subtotal PTX) with a cervical remnant and total parathyroidectomy with autotransplantation (total PTX+AT) are the standard procedures, although both are associated with high recurrence rates (4-7). A considerable quantity of functioning parathyroid tissue is left after each of these operations in order to prevent possible hypoparathyroidism and the need for longBackground: Secondary hyperparathyroidism is a common acquired disorder seen in chronic renal failure. It may result in potentially serious complications including metabolic bone diseases, severe atherosclerosis and undesirable cardiovascular events. Parathyroidectomy is required in about 20% of patients after 3-10 years of dialysis and in up to 40% after 20 years. Aims: The aim of the current study was to evaluate the short-term and long-term outcomes of patients with secondary hyperparathyroidism who had undergone total parathyroidectomy with autotransplantation and thymectomy or subtotal parathyroidectomy with thymectomy by the same surgical team during the study period. Study Design: Retrospective comparative study. Methods: Clinical data of 50 patients who underwent parathyroid surgery for secondary hyperparathyroidism between 2003 and 2011 were reviewed retrospectively. Patients were divided into two subgroups of total parathyroidectomy with autotransplantation or subtotal parathyroidectomy. Thymectomy was routinely performed for both groups. Short term outcome parameters included intact parathyroid hormone, ionized calcium and alkaline phosphatase levels. Bone pain, bone fractures, persistent or recurrent disease were included in long term outcome parameters. Results: The mean duration of dialysis was eight years. The mean ionized calcium levels dropped significantly in the total parathyroidectomy with autotransplantation group (p=0.016). No serious postoperative complications were observed. Postoperative intravenous calcium supplementation was required in four patients in the total parathyroidectomy with autotransplantation group (total PTX+AT) and in three patients in the subtotal parathyroidectomy group (subtotal PTX). Postoperatively, all patients received oral calcium carbonate and calcitriol. The length of average hospital stay was 5 (3-10) days. Including nine patients who underwent successful renal transplantation pre-operative bone symptoms, hypercalcemia, hyperphosphatemia, and an increased alkaline phosphatase levels were improved or resolved in all patients. After a mean follow-up of 65 months, three patients (6%) had persistent and one (2%) had recurrent disease. Conclusion: Total parathroidectomy with auto...

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“…The indications for surgery in sHPT are still a matter of controversy but the following seems to be generally accepted: severe hypercalcemia or hyperphosphatemia in the context of high iPth plasma levels, clinical signs of HPT, imagistic data suggesting enlarged parathyroid glands, clinical and radiological signs of osteoclastic bone resorbtion (18,19). Medically refractory and tHPT are other recognized indications for surgery (5-7).…”

Section: Discussionmentioning

confidence: 99%

Parathyroidectomy in the treatment of secondary hyperparathyroidism. Clinical and laboratory outcomes/ Paratiroidectomia în tratamentul hiperparatiroidismului secundar. Aspecte clinice şi de laborator

Neagoe¹,

Sala²,

Ionela³

et al. 2014

Romanian Review of Laboratory Medicine

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Total Parathyroidectomy Without Autotransplantation for Secondary Hyperparathyroidism

Abstract: Because of the lower recurrent rate and shorter operative time, total parathyroidectomy without autotransplantation may be an option for treating patients with symptomatic secondary hyperparathyroidism who are not expected to receive kidney transplantation.

Cited by 50 publications

References 21 publications

Częściowe usunięcie przytarczyc versus całkowite usunięcie przytarczyc z autoprzeszczepem we wtórnej nadczynności przytarczyc — jednoośrodkowe, prospektywne badanie w grupie 43 pacjentów

Częściowe usunięcie przytarczyc versus całkowite usunięcie przytarczyc z autoprzeszczepem we wtórnej nadczynności przytarczyc — jednoośrodkowe, prospektywne badanie w grupie 43 pacjentów

Outcomes of Total Parathyroidectomy with Autotransplantation versus Subtotal Parathyroidectomy with Routine Addition of Thymectomy to both Groups: Single Center Experience of Secondary Hyperparathyroidism

Parathyroidectomy in the treatment of secondary hyperparathyroidism. Clinical and laboratory outcomes/ Paratiroidectomia în tratamentul hiperparatiroidismului secundar. Aspecte clinice şi de laborator

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