Chirurgisches Management des renalen Hyperparathyreoidismus

Lorenz, Kerstin; Sekulla, Carsten; Dralle, Henning

doi:10.1055/s-0030-1262542

Cited by 5 publications

(5 citation statements)

References 31 publications

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“…Considerably less scar tissue is formed with MWA, making it easier to treat recurrences with either surgery or repeat MWA. Third, although the use of MWA for severe SHPT was based on the same indications recommended for parathyroidectomy, in actuality, the indications for parathyroidectomy for SHPT are not well established [11].…”

Section: Discussionmentioning

confidence: 99%

Microwave ablation: an effective treatment for mild-to-moderate secondary hyperparathyroidism in patients undergoing haemodialysis

Wang

Liu

et al. 2017

International Journal of Hyperthermia

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Section: Discussionmentioning

confidence: 99%

Microwave ablation: an effective treatment for mild-to-moderate secondary hyperparathyroidism in patients undergoing haemodialysis

Wang

Liu

et al. 2017

International Journal of Hyperthermia

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“…Reoperation determined that inadequate cervical explorations occurred in 42 % of patients who had undergone subtotal PTX and in 34 % of patients who had undergone TPTX+AT. Some experts consider subtotal PTX as the most favourable approach for patients with a realistic chance of short-term kidney transplantation and mild to moderate renal HPT [41,42]. An unresolved controversy addresses the possible deterioration of renal function due to PTX, especially in renal transplant patients.…”

Section: Surgical Concepts In Renal Hyperparathyroidismmentioning

confidence: 99%

“…Based on this very recent study and a previous systematic review [40], it may be postulated that routine complete BCT is essential during subtotal PTX and TPTX+AT, especially if fewer than four glands were identified in typical position to avoid recurrence/persistence of renal HPT (EL 3; rec B). Because of the low frequency of supernumerary IPGs and a suspected low-proliferation stimulus, the relevance of BCT after resection of four glands in predialytic patients and those after successful kidney transplantation has to be questioned [41,42] (Table 5). There is presently no sufficient data to give a definitive statement about the value of routine BCT during TPTX without autotransplantation.…”

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

108

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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“…These studies imply that total PTx is favored for patients who need long-term dialysis, although special attention is necessary for cardiovascular events. However, subtotal PTx can be indicated for patients with SHPT expecting kidney transplantation in the near future ( 70 , 71 ).…”

Section: Comparison Of Ptx Proceduresmentioning

confidence: 99%

Treatment for secondary hyperparathyroidism focusing on parathyroidectomy

et al. 2023

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Secondary hyperparathyroidism (SHPT) is a major problem for patients with chronic kidney disease and can cause many complications, including osteodystrophy, fractures, and cardiovascular diseases. Treatment for SHPT has changed radically with the advent of calcimimetics; however, parathyroidectomy (PTx) remains one of the most important treatments. For successful PTx, removing all parathyroid glands (PTGs) without complications is essential to prevent persistent or recurrent SHPT. Preoperative imaging studies for the localization of PTGs, such as ultrasonography, computed tomography, and 99mTc-Sestamibi scintigraphy, and intraoperative evaluation methods to confirm the removal of all PTGs, including, intraoperative intact parathyroid hormone monitoring and frozen section diagnosis, are useful. Functional and anatomical preservation of the recurrent laryngeal nerves can be confirmed via intraoperative nerve monitoring. Total or subtotal PTx with or without transcervical thymectomy and autotransplantation can also be performed. Appropriate operative methods for PTx should be selected according to the patients’ need for kidney transplantation. In the case of persistent or recurrent SHPT after the initial PTx, localization of the causative PTGs with autotransplantation is challenging as causative PTGs can exist in the neck, mediastinum, or autotransplanted areas. Additionally, the efficacy and cost-effectiveness of calcimimetics and PTx are increasingly being discussed. In this review, medical and surgical treatments for SHPT are described.

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Chirurgisches Management des renalen Hyperparathyreoidismus

Cited by 5 publications

References 31 publications

Microwave ablation: an effective treatment for mild-to-moderate secondary hyperparathyroidism in patients undergoing haemodialysis

Microwave ablation: an effective treatment for mild-to-moderate secondary hyperparathyroidism in patients undergoing haemodialysis

Surgical management of secondary hyperparathyroidism in chronic kidney disease—a consensus report of the European Society of Endocrine Surgeons

Treatment for secondary hyperparathyroidism focusing on parathyroidectomy

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