Re-operative parathyroidectomy: How many positive localization studies are required? |
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| Institution: | 1. Department of Surgery, Nagasaki University Graduate School of Biomedical Sciences, 1-7-1 Sakamoto, Nagasaki 852-8501, Japan;2. Department of Surgery, Nishi Isahaya Hospital, Isahaya, Japan;3. Department of Laboratory Medicine, Nagasaki University Hospital, Nagasaki, Japan;1. Department of Nuclear Medicine, Hospital Clinic, Barcelona, Spain;2. Department of Maxillofacial Surgery, Hospital Clinic, Barcelona, Spain;1. Department of Surgery, The University of Virginia Health System, P.O. Box 800681, Charlottesville, VA, 22908, USA;2. Endocrine Surgery, Department of Surgery, The Johns Hopkins University School of Medicine, 600 North Wolfe Street, Blalock 606, Baltimore, MD, 21287, USA;3. Surgical Oncology Program, National Cancer Institute, National Institutes of Health, Bethesda, MD, 20892, USA;1. Department of Radiology and Department of Medical and Health Sciences, Linköping, Sweden;2. Center for Medical Image Science and Visualization (CMIV), Linköping University, Linköping, Sweden;3. Department of Surgery in Linköping, and Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden;4. Department of Surgery Västervik and Faculty of Medicine and Health, Örebro University Hospital, Sweden;5. Faculty of Medicine and Health, Örebro University Hospital, Örebro, Sweden;6. Department of Acute Internal Medicine and Geriatrics in Linköping, and Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden |
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| Abstract: | BackgroundRe-operative parathyroidectomy in patients with recurrent or persistent hyperparathyroidism can be challenging. We review our experience to determine the optimal number of localization studies prior to re-operation.MethodsFrom 2001 to 2019, 251 patients underwent re-operative parathyroidectomy. Parathyroidectomies were stratified to 4 groups based upon the number of positive localization studies obtained: A) ZERO, B) 1-positive, C) 2-positive, D) 3-positive.ResultsThe overall cure rate was 97%, where 201 single gland resections, 23 two-gland resections, 22 subtotal/total, and 5 forearm autograft resections were performed. Thirty-two patients had no positive studies (A), 172 patients had 1-positive (B), 42 patients had 2-positive (C), and 5 patients had 3-positive studies (D). There was no difference in surgical cure rates between groups (p = 0.71). The majority of patients had one or no positive imaging studies yet almost all still achieved cure.ConclusionSuccessful re-operative parathyroidectomy can be performed with minimal pre-operative scans in certain clinical contexts. |
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| Keywords: | Endocrine surgery Localization Reoperative parathyroidectomy Hyperparathyroidism |
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