Elsevier

Surgery

Volume 146, Issue 6, December 2009, Pages 1130-1137
Surgery

American Association of Endocrine Surgeon
Tertiary hyperparathyroidism: Is less than a subtotal resection ever appropriate? A study of long-term outcomes

https://doi.org/10.1016/j.surg.2009.09.026Get rights and content

Background

Our aim was to examine the outcomes of patients with tertiary hyperparathyroidism (3-HPT) who had limited resection of 1 or 2 parathyroids.

Methods

We reviewed 140 patients with 3-HPT who underwent parathyroidectomy (PTX) at a single institution. Patients were analyzed according to their operation—limited PTX versus subtotal or total PTX.

Results

The limited PTX group consisted of 29 patients who underwent resection of 1 (n = 12) or 2 (n = 17) parathyroids. The other 111 patients had subtotal (n = 104), total (n = 3), and/or reoperative PTX (n = 12). The mean ± SEM follow-up was 79 ± 5 months. Eucalcemia was achieved in 94% of the patients. All patients with persistent (n = 2) hypercalcemia underwent subtotal PTX (P = not significant [NS] vs limited PTX). In a logistic regression model, the extent of operation was not associated with the development of recurrent disease. Additionally, the incidence of permanent hypocalcemia was 7% after subtotal or total PTX versus 0% after limited resection (P = NS).

Conclusion

Long-term outcomes in patients with 3-HPT appear to be similar after appropriate limited resection of 1 or 2 parathyroid glands compared to subtotal or total PTX. Therefore, a strategy of limited parathyroid resection seems appropriate for patients with 3-HPT when the disease is limited to 1 or 2 glands.

Section snippets

Methods

A retrospective review of all patients with 3-HPT who underwent PTX at the University of Wisconsin between January 1984 and June 2008 by 4 endocrine surgeons was performed. Patients were considered to have 3-HPT if they were diagnosed previously with 2-HPT, underwent renal transplantation, and continued to have increased serum levels of intact PTH (iPTH) after normalization of renal function. PTX was undertaken if patients remained hypercalcemic (serum calcium >10.2 mg/dL) for more than 1 year

Results

We reviewed 140 patients with 3-HPT who underwent PTX (n = 148) during the study period. The limited PTX group consisted of 29 patients who underwent resection of 1 (n = 12) or 2 (n = 17) parathyroid glands. The 111 patients in the subtotal or total PTX group underwent 119 operations: subtotal PTX (n = 104), total PTX with autograft (n = 3), or reoperative PTX (n = 12). In the subtotal or total PTX group, 8 patients underwent 2 operations at our hospital, including 7 after an initial 3.5-gland

Discussion

The purpose of this study was to analyze the outcomes of patients with 3-HPT who underwent limited resection and to determine whether this selective approach is ever appropriate. The results demonstrate that long-term outcomes in patients with 3-HPT are similar for those undergoing appropriate limited resection of 1 or 2 parathyroid glands compared to those undergoing subtotal or total PTX. Patients who underwent limited resection had comparable laboratory values, operative times, durations of

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Presented at the 30th Annual Meeting of the American Association of Endocrine Surgeons, Madison, Wisconsin, May 2–5, 2009.

Supported in part by research grants from the American College of Surgeons Resident Research Scholarship and the National Institutes of Health (grant T32 CA009614-19 Physician Scientist Training in Cancer Medicine).

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