Increasing trend of bilateral neck exploration in primary hyperparathyroidism |
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| Affiliation: | 1. NorthShore University HealthSystem, Department of Surgery, Evanston, IL, USA;2. University of Chicago, Department of Surgery, Chicago, IL, USA;3. Bioinformatics and Research Core, NorthShore University HealthSystem, Evanston, IL, USA;1. MetroHealth Medical Center, Department of Surgery, Division of Trauma, Critical Care, Burns, & Acute Care Surgery, Cleveland, OH, USA;2. Cleveland Clinic Foundation, Digestive Disease Institute, Department of General Surgery, Cleveland, OH, USA;1. Department of Colorectal Surgery, Digestive Disease and Surgery Institute, Cleveland Clinic, 9500 Euclid Avenue, A-30, Cleveland, OH, 44195, USA;2. Quantitative Health Sciences, Lerner Research Institute, Cleveland Clinic, Cleveland, OH, USA;3. Division of Colorectal Surgery, University Hospitals Cleveland Medical Center, Cleveland, USA;1. Wayne State University School of Medicine, Michael & Marian Ilitch Department of Surgery, Detroit, MI, USA;2. Ascension St. John Hospital, Department of Surgery, Detroit, MI, USA;1. Department of Surgical Oncology, Section of Endocrine Surgery, University of Texas MD Anderson Cancer Center, Houston, TX;2. Department of Surgery, Section of Endocrine Surgery, Medical College of Wisconsin, Milwaukee, WI;3. Department of Surgery, Division of Surgical Oncology and Endocrine Surgery, Vanderbilt University Medical Center, Nashville, TN |
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| Abstract: | BackgroundBilateral neck exploration was the standard operation for primary hyperparathyroidism. With improvements in preoperative localization and use of intraoperative PTH (ioPTH) monitoring, minimally invasive unilateral neck exploration has been widely adopted. This study evaluates the trend in parathyroidectomies for primary hyperparathyroidism.MethodsParathyroidectomy for sporadic primary hyperparathyroidism was analyzed from 2010 to 2017. Exclusion criteria included previous neck surgery and concomitant procedures. The operations were classified as unilateral exploration (UE), UE converted to bilateral exploration (BE), or BE. Variables included preoperative and intraoperative factors. Outcomes included persistence, recurrence, permanent hypocalcemia and recurrent laryngeal nerve (RLN) injury.ResultsFour hundred thirty-one patients were reviewed. Since 2010, the rate of BE has increased from 30% to 50%. Disease duration, presence of bone disease, negative localization, baseline ioPTH <100, and ≥2 abnormal glands have increased. Mean operative time has not changed over time. Two percent of patients had persistent disease, <1% had recurrent disease, and 2% have had reoperation. Nine percent had temporary hypoparathyroidism, and 15 patients had temporary RLN injury.ConclusionsThis study shows an increasing trend in BE for primary hyperparathyroidism. This increase was associated with lower baseline intraoperative parathyroid hormone (ioPTH) levels and smaller gland size. The operative approach for parathyroidectomy should be individualized and surgeons should not hesitate to perform BE when needed. |
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| Keywords: | Parathyroidectomy Primary hyperparathyroidism Parathyroid exploration Minimally invasive parathyroidectomy |
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