Is focused parathyroidectomy appropriate for patients with primary hyperparathyroidism?

Abstract

PurposeThe aim of this study was to determine whether focused or complete parathyroidectomy was more appropriate and to compare follow-up data in primary hyperparathyroidism (PHPT).MethodsWe retrospectively analyzed 225 operations for PHPT at Yonsei University Health System between 2000 and 2012. After excluding 93 patients, the remaining 132 were divided into 2 groups: those who underwent focused parathyroidectomy (FP) and those who underwent conventional parathyroidectomy (CP). We compared clinicopathological features; preoperative calcium, parathyroid hormone (PTH), phosphorus, vitamin D, 24-hour urine calcium, and alkaline phosphatase levels; postoperative calcium and PTH levels; pathologic diagnosis; multiplicity; and results of a localization study between the 2 groups.ResultsThere was no significant difference in the rates of development of postoperative persistent hyperparathyroidism (1/122 FP patients and 1/10 CP patients) between the 2 groups due to a technical reason (FP 0.8% vs. CP 10.0%, P = 0.146). Multiglandular disease (MGD) was uncommon in all cases (6 of 132, 4.5%). All MGD cases were diagnosed using a preoperative localization study. Sestamibi scan and ultrasonography sensitivity were 94.2% and 90.2%, respectively.ConclusionWe suggest that FP is appropriate in PHPT, except in cases of MGD if detected before the operation using preoperative imaging. Knowledge of hereditary PHPT and improved preoperative localization studies, such as high-resolution ultrasonography, contributed to the decision to perform FP rather than CP in all cases of unilateral results of the localizing study.

Systematic review of cure and recurrence rates following minimally invasive parathyroidectomy

“…The initial literature search yielded a total of 252 studies, of which 14 , met the inclusion criteria ( Fig . ).…”

“…Of the 14 studies, seven were retrospective , six involved collection of prospectively identified items and one did not clarify the type of study. The median MINORS score was 10 of 16 (mean 9·8, range 6–14) for all studies, and the median of the four comparative studies , was 15 of 24 (mean 14·25, range 10–17).…”

“…The most common type of surgery performed was the open MIP technique , , but other approaches included MIVAP , minimally invasive radio‐guided parathyroidectomy and a totally endoscopic MIP technique. When reported, studies had incision lengths of less than 3 cm, whereas studies that did not report on incision length stated that their procedure was ‘minimally invasive’ or a ‘focused/lateral exploration’.…”

“…Four studies , with a total of 2908 patients performed targeted MIP without IOPTH measurements, and nine studies , carried out targeted MIP with IOPTH measurements in 2072 of the patients. One study made no reference to the use of this test, so was not included in the analysis.…”

“…Surgical management of PHPT has evolved over the past 20 years. Rapid intraoperative parathyroid hormone (IOPTH) assay, sestamibi scintigraphy and radio‐guided parathyroidectomy have emerged, facilitating the development of ‘targeted’ parathyroidectomy techniques based on single‐gland excision via unilateral neck exploration. Various techniques have been described, with a general consensus that parathyroidectomy is classified as ‘minimally invasive’ when performed with preoperative localization through an incision of less than 2·5–3 cm , .…”