Influence of Surgical Volume on Operative Failures for Hyperparathyroidism

Zarebczan, Barbara; Chen, Herbert

doi:10.1016/j.yasu.2011.03.003

Cited by 41 publications

(25 citation statements)

References 39 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Em alguns estudos, HPT terciário corresponde à persistência do HPT após transplante renal bem-sucedido; pode significar também secreção autônoma de PTH decorrente de HPT secundário prolongado (2,3,(5)(6)(7)10,12,13,27,37,38,40,45). Em outros, HPT secundário e terciário são processos relacionados, mas entidades distintas e separadas (13).…”

Section: Discussionunclassified

“…Tratamento cirúrgico do HPT secundário INTRODUÇÃO A s glândulas paratireoides são responsáveis pela síntese e secreção do paratormônio (PTH) (1)(2)(3)(4)(5)(6)(7)(8). Há diversas causas de hipersecreção hormonal, caracterizando parte da doença denominada hiperparatireoidismo (HPT) (1)(2)(3)(4)(5)(6)(7)(8)(9).…”

unclassified

“…Há diversas causas de hipersecreção hormonal, caracterizando parte da doença denominada hiperparatireoidismo (HPT) (1)(2)(3)(4)(5)(6)(7)(8)(9). O HPT secundário é consequência de alterações metabólicas que geram estímulos extraglandulares compensatórios na homeostase mineral, principalmente do cálcio (1)(2)(3)(4)(5)(6)(7)(8)(10)(11)(12).…”

unclassified

“…Existiam cerca de 90 mil pacientes em tratamento dialí-tico no Brasil em 2011, com tendência de aumento ao longo dos anos (35). Estima-se que o HPT secundário seja diagnosticado em cerca de 90% dos pacientes com DRC em hemodiálise (4,7,13,27). A prevalência da doença é elevada, mesmo sendo pouco diagnosticada e tratada (20).…”

unclassified

“…A PTx pode reduzir significativamente os níveis de fosfato e PTH. É tratamento efetivo e seguro, realizado em portadores de HPT secundário refratário (3,7,11 Tratamento cirúrgico do HPT secundário A PTx é indicada para 1% a 30% dos pacientes com até 10 anos de hemodiálise e em cerca de 36% a 40% dos pacientes com mais de 10 anos de tratamento dialítico (1,6,11,18,20,24). Para os transplantados renais, a PTx é realizada entre 0,6% a 32% dos casos (5,37).…”

unclassified

See 4 more Smart Citations

Tratamento cirúrgico do hiperparatireoidismo secundário: revisão sistematizada da literatura

Magnabosco

Tavares

Montenegro

2014

Arq Bras Endocrinol Metab

View full text Add to dashboard Cite

RESUMOO hiperparatireoidismo (HPT) secundário tem prevalência elevada em doentes renais crônicos. Decorre de alterações na homeostase mineral, principalmente do cálcio, que estimulam as glându-las paratireoides, com aumento na secreção de paratormônio (PTH). O estímulo prolongado pode levar à autonomia na função paratireóidea. Inicialmente, o tratamento é clínico, mas a paratireoidectomia (PTx) pode ser necessária. A PTx pode ser total, subtotal e total seguida de autoimplante de tecido paratireóideo. Este trabalho compara as indicações e resultados dessas técnicas na literatura. Foi realizada revisão sistematizada dos trabalhos publicados entre janeiro de 2008 e março de 2014 sobre tratamento cirúrgico do hiperparatireoidismo secundário nas bases de dados MedLine e LILACS. Foram utilizados os termos: hiperparatireoidismo; hiperparatireoidismo secundário; glândulas paratireoides e paratireoidectomia. Foram restritos a pesquisas apenas em humanos; artigos disponíveis em meio eletrônico; publicados em português, espanhol, inglês ou francês. A amostra final foi constituída de 49 artigos. A PTx subtotal e a total mais autoimplante foram as técnicas mais utilizadas, sem consenso sobre a técnica mais efetiva. Embora haja certa preferência pela última, a escolha depende da experiência do cirurgião. Há consenso sobre a necessidade de identificar todas as paratireoides e sobre a criopreservação de tecido paratireóideo, quando possí-vel, para enxerto em caso de hipoparatireoidismo. Exames de imagem podem ser úteis, especialmente nas recidivas. Tratamentos alternativos do HPT secundário, tanto intervencionistas quanto conservadores, carecem de estudos mais aprofundados. Arq Bras Endocrinol Metab. 2014;58(5):562-71 Descritores Hiperparatireoidismo; hiperparatireoidismo secundário; glândulas paratireoides; paratireoidectomia ABSTRACT Secondary hyperparathyroidism (HPT) has a high prevalence in renal patients. Secondary HPT results from disturbances in mineral homeostasis, particularly calcium, which stimulates the parathyroid glands, increasing the secretion of parathyroid hormone (PTH). Prolonged stimulation can lead to autonomy in parathyroid function. Initial treatment is clinical, but parathyroidectomy (PTx) may be required. PTx can be subtotal or total followed or not followed by parathyroid tissue autograft. We compared the indications and results of these strategies as shown in the literature through a systematic literature review on surgical treatment of secondary HPT presented in MedLine and LILACS from January 2008 to March 2014. The search terms were: hyperparathyroidism; secondary hyperparathyroidism; parathyroidectomy and parathyroid glands, restricted to research only in humans, articles available in electronic media, published in Portuguese, Spanish, English or French. We selected 49 articles. Subtotal and total PTx followed by parathyroid tissue autograft were the most used techniques, without consensus on the most effective surgical procedure, although there was a preference for the latter. The choice depend...

show abstract

Section: Discussionunclassified

unclassified

See 3 more Smart Citations

Tratamento cirúrgico do hiperparatireoidismo secundário: revisão sistematizada da literatura

Magnabosco

Tavares

Montenegro

2014

Arq Bras Endocrinol Metab

View full text Add to dashboard Cite

show abstract

Use of Intraoperative Parathyroid Hormone in Minimally Invasive Parathyroidectomy for Primary Hyperparathyroidism

Quinn

Ryan

Garry

et al. 2021

JAMA Otolaryngol Head Neck Surg

View full text Add to dashboard Cite

IMPORTANCEIntraoperative parathyroid hormone (ioPTH) is a surgical adjunct that has been increasingly used during minimally invasive parathyroidectomy (MIP). Despite its growing popularity, to our knowledge a meta-analysis comparing MIP with ioPTH vs MIP without ioPTH has not yet been conducted. OBJECTIVE To evaluate the safety and efficacy of MIP with ioPTH for treatment of primary hyperparathyroidism.DATA SOURCES A systematic search of the databases PubMed, Embase, Scopus, Web of Science, and Cochrane Collaboration was performed to identify studies that compared MIP with and without ioPTH. Data were analyzed between August and September 2019.STUDY SELECTION Inclusion criteria consisted of randomized clinical trials and observational studies with a retrospective/prospective design, comparing MIP using ioPTH vs MIP not using ioPTH for treatment of primary hyperparathyroidism. Eligible studies had to present odds ratio (OR), risk ratio, or hazard ratio estimates (with 95% CI), standard errors, or number of events necessary to calculate these for the outcome of interest rate. Studies involving patients with secondary or tertiary hyperparathyroidism or those with multiple endocrine neoplasia syndrome were excluded.DATA EXTRACTION Two reviewers independently reviewed the literature according to Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) reporting guidelines. Dichotomous variables were pooled as ORs while continuous variables were compared using weighted mean differences. Quality assessment was performed using the Newcastle-Ottawa Scale. MAIN OUTCOMES AND MEASURESThe primary outcome was rate of cure. Secondary outcomes included need for reoperation, need for bilateral neck exploration, morbidity, and length of surgery. RESULTS A total of 12 studies, involving 2290 patients with primary hyperparathyroidism, were eligible for inclusion. The median (SD) age of participants was 60.1 (11.8) years and 77.3% of participants were women. The median Newcastle-Ottawa score was 7. Patients who underwent MIP with ioPTH had higher cure rates (OR, 3.88; 95% CI, 2.12-7.10; P < .001). There was a greater need for reoperation in the group of patients who had surgery without ioPTH (OR, 0.40; 95% CI, 0.19-0.86; P = .02). There was a trend toward longer operating times/increased duration of surgery in the ioPTH group; however, this did not reach statistical significance (weighted mean difference, 21.62 minutes; 95% CI, −0.93 to 44.17 minutes; P = .06). The use of ioPTH was associated with higher rates of bilateral neck exploration (OR, 3.55; 95% CI, 1.27-9.92; P = .02). CONCLUSIONS AND RELEVANCEUse of ioPTH is associated with higher cure rates for patients with primary hyperparathyroidism undergoing MIP. Minimally invasive parathyroidectomy performed without ioPTH is associated with less conversion to bilateral neck exploration at initial surgery but with lower cure rates and an increased risk for reoperation.

show abstract

AHNS Series: Do you know your guidelines? Optimizing outcomes in reoperative parathyroid surgery: Definitive multidisciplinary joint consensus guidelines of the American Head and Neck Society and the British Association of Endocrine and Thyroid Surgeons

et al. 2018

View full text Add to dashboard Cite

Background Revision parathyroid is challenging due to possible diagnostic uncertainty as well as the technical challenges it can present. Methods A multidisciplinary panel of distinguished experts from the American Head and Neck Society (AHNS) Endocrine Section, the British Association of Endocrine and Thyroid Surgeons (BAETS), and other invited experts have reviewed this topic with the purpose of making recommendations based on current best evidence. The literature was also reviewed on May 12, 2017. PubMed (1946‐2017), Cochrane SR (2005‐2017), CT databases (1997‐2017), and Web of Science (1945‐2017) were searched with the following strategy: revision and reoperative parathyroidectomy to ensure completeness. Results Guideline recommendations were made in 3 domains: preoperative evaluation, surgical management, and alternatives to surgery. Eleven guideline recommendations are proposed. Conclusion Reoperative parathyroid surgery is best avoided if possible. Our literature search and subsequent recommendations found that these cases are best managed by experienced surgeons using precision preoperative localization, intraoperative parathyroid hormone (PTH), and the team approach.

show abstract

Influence of Surgical Volume on Operative Failures for Hyperparathyroidism

Cited by 41 publications

References 39 publications

Tratamento cirúrgico do hiperparatireoidismo secundário: revisão sistematizada da literatura

Tratamento cirúrgico do hiperparatireoidismo secundário: revisão sistematizada da literatura

Use of Intraoperative Parathyroid Hormone in Minimally Invasive Parathyroidectomy for Primary Hyperparathyroidism

AHNS Series: Do you know your guidelines? Optimizing outcomes in reoperative parathyroid surgery: Definitive multidisciplinary joint consensus guidelines of the American Head and Neck Society and the British Association of Endocrine and Thyroid Surgeons

Contact Info

Product

Resources

About