Prevertebral cervical approach: a pure endoscopic surgical technique for posterior mediastinum parathyroid adenomas

Martos-Martínez, Juan Manuel; Sacristán-Pérez, Cristina; Pérez-Andrés, Marina; Durán-Muñoz-Cruzado, Virginia María; Pino-Díaz, Verónica; Padillo-Ruíz, Javier

doi:10.1007/s00464-016-5197-y

Cited by 3 publications

(1 citation statement)

References 29 publications

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“…In absence of suitable indicators of malignancy, surgeons will consider practicalities of access to thoracic lesions rather than oncological principles. Many ectopic mediastinal lesions can be accessed and removed by a low standard cervical Kocher incision [ 74 ] or minimally invasive access techniques [ 75 , 76 ], including video-assisted thoracoscopy VATS [ 77 , 78 , 79 , 80 ], or robot-assisted approaches [ 81 ]. Different from the experience in neck surgery, such approaches disable a comprehensive intraoperative circumspection and palpation of the lesion site before tissue planes are opened.…”

Section: Discussionmentioning

confidence: 99%

Mediastinal Parathyroid Cancer

Schulte

Galatà

Talat

2022

Cancers

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Parathyroid cancer (PC) is rare, but its pre-operative recognition is important to choose appropriate access strategies and achieve oncological clearance. This study characterizes features of mediastinal parathyroid cancer (MPC) and explores criteria aiding in the pre-operative recognition of malignancy. We assembled data from 502 patients with mediastinal parathyroid neoplasms (MPNs) from a systematic review of the literature 1968–2020 (n = 467) and our own patient cohort (n = 35). Thirty-two of the 502 MPNs (6.4%) exhibited malignancy. Only 23% of MPC patients underwent oncological surgery. Local persistence and early recurrence at a median delay of 24 months were frequent (45.8%), and associated with a 21.7-fold (95%CI 1.3–351.4; p = 0.03) higher risk of death due to disease. MPCs (n = 30) were significantly larger than cervical PC (n = 330), at 54 ± 36 mm vs. 35 ± 18 mm (χ2 = 20; p < 0.0001), and larger than mediastinal parathyroid adenomas (MPA; n = 226) at 22 ± 15 mm (χ2 = 33; p < 0.01). MPC occurred more commonly in males (60%; p < 0.01), with higher calcium (p < 0.01) and parathyroid hormone (PTH) levels (p < 0.01) than MPA. Mediastinal lesions larger than 3.0 cm and associated with a corrected calcium ≥ 3.0 mM are associated with a more than 100-fold higher odds ratio of being malignant (OR 109.2; 95%CI 1.1–346; p < 0.05). The composite 3 + 3 criterion recognized 74% of all MPC with an accuracy of 83%. Inversely, no MPN presenting with a calcium < 3.0 mM and size < 3.0 cm was malignant. When faced with pHPT in mediastinal location, consideration of the 3 + 3 rule may trigger an oncological team approach based on simple, available criteria.

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