Systematic review of incidence, risk factors, prevention and treatment of post-laryngectomy hypoparathyroidism

Abstract

Purpose Post-laryngectomy hypoparathyroidism is associated with significant short- and long-term morbidities. This systematic review aimed to determine incidence, risk factors, prevention and treatment of post-laryngectomy hypoparathyroidism. Methods Medline, EMBASE and the Cochrane library were searched for relevant articles on hypocalcaemia and/or hypoparathyroidism after laryngectomy or pharyngectomy. Two authors independently screened titles and abstracts from the search. Data from individual studies were collated and presented (without meta-analysis). Quality assessment of included studies was undertaken. The review protocol was registered in the PROSPERO database (CRD42019133879). Results Twenty-three observational studies were included. The rates of transient and long-term hypoparathyroidism following laryngectomy with concomitant hemi- or total thyroidectomy ranged from 5.6 to 57.1% (n = 13 studies) and 0 to 12.8% (n = 5 studies), respectively. Higher transient (62.1–100%) and long-term (12.5–91.6%) rates were reported in patients who had concomitant oesophagectomy and total thyroidectomy (n = 4 studies). Other risk factors included bilateral selective lateral neck dissection, salvage laryngectomy and total pharyngectomy. There is a lack of data on prevention and management. Conclusion Hypoparathyroidism occurs in a significant number of patients after laryngectomy. Patients who underwent laryngectomy with concomitant hemithyroidectomy may still develop hypoparathyroidism. Research on prevention and treatment is lacking and needs to be encouraged.

Hypocalcaemia in pharyngolaryngectomy: Preservation or autotransplantation of parathyroid glands

“…Published rates of hypocalcaemia following pharyngolaryngectomy are variable, ranging between 15% and 65%. 1 , 5 , 6 However, this study of 30 pharyngolaryngectomy patients demonstrates that lower rates of transient (13%) and permanent (10%) hypocalcaemia are achievable.…”

“…Definitions of hypocalcaemia are variable in the literature, with authors utilizing various corrected calcium cut‐offs, 4 , 6 , 9 parathyroid hormone (PTH) levels, 10 or requirement for calcium and vitamin D supplementation. 3 , 5 Further, the duration of permanent hypocalcaemia has differed in the literature between 6 and 12 months. 3 , 4 , 5 , 11 Our approach was to utilize local definitions of hypocalcaemia (based upon corrected calcium).…”

“…Previous authors have identified various risk factors for postoperative transient and permanent hypocalcaemia, including; total thyroidectomy, 4 salvage laryngectomy, total pharyngectomy, 5 and bilateral neck dissection. 5 , 6 Often patients undergoing laryngectomy and pharyngolaryngectomy are paired together in retrospective analysis.…”

Postoperative Hypokalzämie – die häufigste Komplikation der endokrinen Chirurgie der Halsregion: Akutes Management

“…Edafe et al publizierten in einer Metaanalyse Inzidenzen von 5,6-57,1 % bzw. 0-12,8 % für einen permanenten HypoPT [10]. Die totale Laryngektomie stellte mit etwa 1114 Operationen 4,3 % aller Eingriffe im Bereich des Larynx im Jahr 2019 dar, wobei aus den Daten nicht der Anteil mit gleichzeitiger Schilddrüsenoperation entnommen werden kann [36].…”

“…Die totale Laryngektomie stellte mit etwa 1114 Operationen 4,3 % aller Eingriffe im Bereich des Larynx im Jahr 2019 dar, wobei aus den Daten nicht der Anteil mit gleichzeitiger Schilddrüsenoperation entnommen werden kann [36]. Insgesamt erscheint der HypoPT nach Laryngektomie ohne Schilddrüsenresektion eher eine Rarität zu sein [10].…”