Parathyroidectomy in secondary hyperparathyroidism

Is there an optimal operative management?

Melanie L. Richards, Jennifer Wormuth, Juliane Bingener, Kenneth Sirinek

Research output: Contribution to journalArticle

79 Citations (Scopus)

Abstract

Background. Subtotal parathyroidectomy (SPTX) and total PTX with autotransplantation (TPTX + AT) are both accepted operations for secondary hyperparathyroidism (2HPT). Studies have shown the 2 procedures to have similar rates of recurrent or persistent HPT (0% to 10%). The majority of these reports are small case series and despite apparently similar outcomes; the optimal operative management for 2HPT remains controversial. The purpose of this study was to determine whether there were any clinical outcome differences between these apparently comparable operations. Methods. A meta-analysis of 53 publications on reoperative operation for 2HPT from 1983 to 2004 identified 501 patients who had undergone an operation for recurrent or persistent 2HPT. The data evaluated included the type of initial operation, the need for reoperative operation as it related to the type of initial operation, and the intraoperative findings. Results. The initial operation had been a SPTX in 36% and a TPTX + AT in 64% of patients. Reoperative operation was for persistent 2HPT in 82 of 485 (17%) and for recurrent 2HPT in 403 of 485 (83%) patients. Findings at reoperation included: autograft hyperplasia (49%), supernumerary glands (20%), remnant hyperplasia (17%), a missed in situ gland (7%), and a negative exploration (5%). Supernumerary glands, missed in situ glands, and negative explorations occurred at equal rates for both operations. Reoperation determined that inadequate cervical explorations occurred in 42% of patients who had undergone a SPTX and in 34% of patients who had undergone a TPTX + AT. Conclusions. Operative failures occur because of the limitations in preoperative localization, inadequate exploration, and the natural history of hyperplastic parathyroid tissue. The initial operation should include an attempt to localize supernumerary glands both pre- and intra-operatively.

Original languageEnglish (US)
Pages (from-to)174-180
Number of pages7
JournalSurgery
Volume139
Issue number2
DOIs
StatePublished - Feb 2006
Externally publishedYes

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Parathyroidectomy
Secondary Hyperparathyroidism
Reoperation
Hyperplasia
Autologous Transplantation
Autografts
Natural History
Publications
Meta-Analysis

ASJC Scopus subject areas

  • Surgery

Cite this

Parathyroidectomy in secondary hyperparathyroidism : Is there an optimal operative management? / Richards, Melanie L.; Wormuth, Jennifer; Bingener, Juliane; Sirinek, Kenneth.

In: Surgery, Vol. 139, No. 2, 02.2006, p. 174-180.

Research output: Contribution to journalArticle

Richards, Melanie L. ; Wormuth, Jennifer ; Bingener, Juliane ; Sirinek, Kenneth. / Parathyroidectomy in secondary hyperparathyroidism : Is there an optimal operative management?. In: Surgery. 2006 ; Vol. 139, No. 2. pp. 174-180.
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abstract = "Background. Subtotal parathyroidectomy (SPTX) and total PTX with autotransplantation (TPTX + AT) are both accepted operations for secondary hyperparathyroidism (2HPT). Studies have shown the 2 procedures to have similar rates of recurrent or persistent HPT (0{\%} to 10{\%}). The majority of these reports are small case series and despite apparently similar outcomes; the optimal operative management for 2HPT remains controversial. The purpose of this study was to determine whether there were any clinical outcome differences between these apparently comparable operations. Methods. A meta-analysis of 53 publications on reoperative operation for 2HPT from 1983 to 2004 identified 501 patients who had undergone an operation for recurrent or persistent 2HPT. The data evaluated included the type of initial operation, the need for reoperative operation as it related to the type of initial operation, and the intraoperative findings. Results. The initial operation had been a SPTX in 36{\%} and a TPTX + AT in 64{\%} of patients. Reoperative operation was for persistent 2HPT in 82 of 485 (17{\%}) and for recurrent 2HPT in 403 of 485 (83{\%}) patients. Findings at reoperation included: autograft hyperplasia (49{\%}), supernumerary glands (20{\%}), remnant hyperplasia (17{\%}), a missed in situ gland (7{\%}), and a negative exploration (5{\%}). Supernumerary glands, missed in situ glands, and negative explorations occurred at equal rates for both operations. Reoperation determined that inadequate cervical explorations occurred in 42{\%} of patients who had undergone a SPTX and in 34{\%} of patients who had undergone a TPTX + AT. Conclusions. Operative failures occur because of the limitations in preoperative localization, inadequate exploration, and the natural history of hyperplastic parathyroid tissue. The initial operation should include an attempt to localize supernumerary glands both pre- and intra-operatively.",
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