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Casella C, Guarneri C, Campanile M, Adhoute X, Gelera PP, Morandi R. Surgical treatment of tertiary hyperparathyroidism: does one fit for all? Front Endocrinol (Lausanne) 2023; 14:1226917. [PMID: 38027172 PMCID: PMC10652876 DOI: 10.3389/fendo.2023.1226917] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Accepted: 09/20/2023] [Indexed: 12/01/2023] Open
Abstract
Background Tertiary hyperparathyroidism (3HPT) is defined as a condition of excessive autonomous excretion of intact parathyroid hormone (iPTH) with persistent hypercalcemia (>10.5 mg/dL) that lasts for more than 12 months after a successful kidney transplantation, in the context of a long course secondary hyperparathyroidism (2HPT). The chronic high levels of iPTH cause a worsening of graft function, accompanied by systemic symptoms of hypercalcemia. The only curative therapy is parathyroidectomy (PTX). It remains unclear whether total parathyroidectomy with autotransplantation (TPTX-AT) or subtotal parathyroidectomy (SPTX) lead to better outcomes. Aims The aim of this retrospective, single-institution cohort study is to evaluate the rate of persistent or recurrent disease and postoperative calcium/iPTH disturbances in patients treated with TPTX-AT or SPTX for 3HPT. Methods A single-center retrospective analysis of 3HPT patients submitted to TPTX-AT or SPTX between 2007-2020 with at least 24 months follow-up was conducted. The outcome parameters included persistence/recurrence of disease, incidence of transitory hypocalcemia, and temporary/permanent hypoparathyroidism. Results A cohort of 52 patients was analyzed and divided in two groups: 38 (73%) were submitted for TPTX-AT, and 14 patients (27%) were submitted for SPTX. The TPTX-AT population showed lower plasmatic calcium concentrations compared with the SPTX group during the entire follow-up period (p<0.001). There were eight cases (21%) of transitory hypocalcemia in the TPTX-AT group and none in the SPTX group, with p=0.065. Two cases (5%) of temporary hypoparathyroidism occurred in the TPTX-AT group and none in the SPTX group, with p= 0.530. There were no cases of permanent hypoparathyroidism and no cases of persistent disease. No statistical difference was assessed for the recurrence of 3HPT between the TPTX-AT group and the SPTX group (N=1, 3% vs N=1, 7%) (p=0.470). Conclusion No significative difference was registered between the TPTX-AT and SPTX groups in terms of persistence/recurrence of disease, incidence of transitory hypocalcemia, and temporary/permanent hypoparathyroidism. Mean calcium levels iPTH values were statistically lower among the TPTX-AT group compared with the SPTX group while remaining always in the range of normality.
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Affiliation(s)
- Claudio Casella
- Department of Molecular and Translational Medicine, Surgical Clinic, University of Brescia, Brescia, Italy
| | - Claudio Guarneri
- Department of Clinical and Experimental Sciences, Surgical Clinic, University of Brescia, Brescia, Italy
| | - Manuela Campanile
- Service de Chirurgie Digestive et Endocrinienne, Hôpital Saint Joseph, Marseille, France
| | - Xavier Adhoute
- Service d’Hépato-Gastro-Entérologie, Hôpital Saint Joseph, Marseille, France
| | - Pier Paolo Gelera
- Department of Clinical and Experimental Sciences, Surgical Clinic, University of Brescia, Brescia, Italy
| | - Riccardo Morandi
- Department of Clinical and Experimental Sciences, Surgical Clinic, University of Brescia, Brescia, Italy
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Comparison of different parathyroid autograft project after total parathyroidectomy in patients with secondary hyperparathyroidism. Am J Otolaryngol 2021; 42:103085. [PMID: 34049172 DOI: 10.1016/j.amjoto.2021.103085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2021] [Accepted: 05/16/2021] [Indexed: 11/23/2022]
Abstract
OBJECTIVE To evaluate the feasibility and efficacy of total parathyroidectomy followed by modified needle-quantified injection of parathyroid autograft compared with classic incision and transplantation. METHODS We conducted a retrospective study of 171 patients with secondary hyperparathyroidism treated by hemodialysis or peritoneal dialysis. These patients were included in our study from April 2006 to December 2016, who had undergone total parathyroidectomies with autotransplantation. Patients were divided into classic incision for transplantation of parathyroid autograft group and modified needle-quantified injection group. Clinical and biochemical characteristics, including preoperative and postoperative intact parathyroid hormone levels were recorded and compared between two group patients. RESULTS To compare the techniques of modified needle-quantified injection and classic incision and transplantation, pre- and postoperative biochemistry and length of operation was recorded and analyzed. Preoperative biochemistry was similarly in both groups. However, autograft function achieved was significantly faster in the group with modified needle-quantified injection compared with classic incision and transplantation (P = 0.03). Median time to parathyroid function regain was 3 months for injection compared with 7 months for classic incision. There was no remarkable difference in the recurrence rates between the two groups. CONCLUSION The modified needle-quantified injection of parathyroid tissue is a feasible and simple alternative to the more commonly used method of classic incision and transplantation.
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Lin D, Nie S, Li X, Ni Z, Chen Y, Yan L, Jin H, Huang H. Total Parathyroidectomy with Forearm Muscle Autotransplantation Versus Subtotal Parathyroidectomy for Secondary Hyperparathyroidism: a Systematic Review and Meta-analysis. Indian J Surg 2021. [DOI: 10.1007/s12262-020-02410-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
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Gu C, Ye Z, Wang Y, Wang Q, Qi J, Chen J, Chen S, Xu Z. Therapeutic efficacy of two surgical methods on the secondary hyperparathyroidism. Gland Surg 2020; 9:321-328. [PMID: 32420256 DOI: 10.21037/gs.2020.03.08] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Background This study aimed to investigate the clinical efficacy of two surgical methods on hyperparathyroidism secondary to uremia and summarize the advantages and disadvantages of both methods. Methods Uremic patients who received parathyroidectomy (PTX) in the last 3 years were divided into two groups according to the surgical methods used [subtotal parathyroidectomy (SPTX) group and total parathyroidectomy + autologous implantation (TPTX + AT) group]. TPTX was performed if less than 4 glands were found during surgery. The changes of various indexes after operation, and calculate the success rate and recurrence rate of patients were observed. The serum biochemical parameters were routinely monitored, the success rate, postoperative complications and recurrence were recorded. The patients were followed up. Results There were 20 patients in the SPTX group and 12 in the TPTX + AT group. The success rate of surgery was 85% and 91.7% in the SPTX group and TPTX + AT group, respectively, among 32 patients included for final analysis. The mean PTH and postoperative ALP in the TPTX + AT group were slightly lower than in the SPTX group, except for the PTH levels at 6 months after surgery (P<0.05). The incidence of postoperative hypocalcemia was 100% in both groups. The incidence of wound infection in the two groups was 0% and 16.7% in the SPTX group and TPTX + AT group, respectively. The mean calcium supplementation in the TPTX + AT group was significantly more than in the SPTX group within 1 year after surgery. The mean postoperative bone mineral density in the SPTX group was significantly higher than in the TPTX + AT group. The time to postoperative remission of bone pain and muscle weakness was markedly shorter in the SPTX group than in the TPTX + AT group. The post-operative quality of life (QOL) in the SPTX group was significantly better than in the TPTX + AT group. Conclusions These findings suggest that SPTX achieves a better short-term efficacy, but TPTX + AT has a better long-term efficacy. Therefore, the selection of surgical method for PTX may be based on the age, estimated survival time and possibility of kidney transplantation.
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Affiliation(s)
- Chao Gu
- Department of General Surgery, The Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou 215000, China
| | - Zhenyu Ye
- Department of General Surgery, The Second Affiliated Hospital of Soochow University, Suzhou 215000, China
| | - Yanan Wang
- Science and Technology Office, The Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou 215000, China
| | - Qin Wang
- Department of General Surgery, The Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou 215000, China
| | - Jie Qi
- Department of General Surgery, The Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou 215000, China
| | - Jianhua Chen
- Department of General Surgery, The Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou 215000, China
| | - Shan Chen
- Department of Endocrinology, The Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou 215000, China
| | - Zekuan Xu
- Department of General Surgery, The First Affiliated Hospital of Nanjing Medical University, Nanjing 210000, China
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Kim MS, Kim GH, Lee CH, Park JS, Lee JY, Tae K. Surgical Outcomes of Subtotal Parathyroidectomy for Renal Hyperparathyroidism. Clin Exp Otorhinolaryngol 2020; 13:173-178. [PMID: 32075361 PMCID: PMC7248609 DOI: 10.21053/ceo.2019.01340] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2019] [Accepted: 10/28/2019] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVES The aim of this study was to evaluate the effectiveness of subtotal parathyroidectomy for patients with renal hyperparathyroidism. METHODS We studied 25 patients with renal hyperparathyroidism who underwent subtotal parathyroidectomy from October 2002 to October 2017. We analyzed serum intact parathyroid hormone (iPTH), calcium, and inorganic phosphorus levels before and at multiple time points following surgery, and evaluated the surgical outcomes and complications. RESULTS Of the 25 patients, 13 (52%) were male and 12 (48%) were female, and the mean age was 53.4±9.3 years. The mean duration of dialysis before parathyroidectomy was 156.8±79.5 months. Mean preoperative serum iPTH and calcium levels were 1,199.0±571.3 pg/mL and 10.5±1.0 mg/dL, respectively. At 6 months postoperatively, the mean iPTH and calcium levels decreased to 49.2±47.6 pg/mL (P<0.01) and 8.0±1.0 mg/dL (P<0.01), respectively. Recurrent hyperparathyroidism occurred in two patients: one subsequently underwent kidney transplantation and the other continued hemodialysis and maintained normal calcium levels. One patient developed postoperative permanent hypoparathyroidism. CONCLUSION Subtotal parathyroidectomy is a safe and effective surgical treatment for renal hyperparathyroidism.
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Affiliation(s)
- Min Song Kim
- Department of Otolaryngology-Head and Neck Surgery, Hanyang University College of Medicine, Seoul, Korea
| | - Gheun-Ho Kim
- Department of Internal Medicine, Hanyang University College of Medicine, Seoul, Korea
| | - Chang Hwa Lee
- Department of Internal Medicine, Hanyang University College of Medicine, Seoul, Korea
| | - Joon-Sung Park
- Department of Internal Medicine, Hanyang University College of Medicine, Seoul, Korea
| | - Ji Young Lee
- Department of Radiology, Hanyang University College of Medicine, Seoul, Korea
| | - Kyung Tae
- Department of Otolaryngology-Head and Neck Surgery, Hanyang University College of Medicine, Seoul, Korea
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Yu Y, Zhu CF, Fu X, Xu H. Sagliker syndrome: A case report of a rare manifestation of uncontrolled secondary hyperparathyroidism in chronic renal failure. World J Clin Cases 2019; 7:3792-3799. [PMID: 31799306 PMCID: PMC6887613 DOI: 10.12998/wjcc.v7.i22.3792] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2019] [Revised: 10/03/2019] [Accepted: 10/15/2019] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Sagliker syndrome (SS) resulting from uncontrolled secondary hyperparathyroidism (SHPT) in chronic renal failure (CRF) is seldom reported.
CASE SUMMARY A 24-year-old woman presented with asymmetric facial deformity and stature shortening. She was diagnosed with SS, SHPT, CRF, and thyroid cancer. The patient underwent a total parathyroidectomy and thyroidectomy with central lymph node dissection. The patient’s condition was stable and was discharged from the hospital.
CONCLUSION Undergoing dialysis vintage, presenting high serum phosphate levels, and female gender may be risk factors for SS. Intramembranous ossification in the craniomaxillofacial region is possibly activated in this special pathophysiological condition. What’s more, the choice of surgery mainly depends on the treatment goal and the experience of the individual surgeon.
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Affiliation(s)
- Yu Yu
- Department of General Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Discipline Construction Research Center of China Hospital Development Institute, Shanghai Jiao Tong University, Shanghai 200011, China
| | - Chen-Fang Zhu
- Department of General Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Discipline Construction Research Center of China Hospital Development Institute, Shanghai Jiao Tong University, Shanghai 200011, China
| | - Xiao Fu
- Department of General Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Discipline Construction Research Center of China Hospital Development Institute, Shanghai Jiao Tong University, Shanghai 200011, China
| | - Hua Xu
- Department of General Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Discipline Construction Research Center of China Hospital Development Institute, Shanghai Jiao Tong University, Shanghai 200011, China
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Yuan Q, Liao Y, Zhou R, Liu J, Tang J, Wu G. Subtotal parathyroidectomy versus total parathyroidectomy with autotransplantation for secondary hyperparathyroidism: an updated systematic review and meta-analysis. Langenbecks Arch Surg 2019; 404:669-679. [PMID: 31377854 DOI: 10.1007/s00423-019-01809-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2019] [Accepted: 07/23/2019] [Indexed: 12/15/2022]
Abstract
PURPOSE The optimal surgical approach of parathyroidectomy for patients with secondary hyperparathyroidism (SHPT) has been controversial. The updated meta-analysis aimed to compare the effectiveness of subtotal parathyroidectomy (SPTX) versus total parathyroidectomy with autotransplantation (TPTX + AT). METHODS A thorough systematic search was performed on the databases of PubMed, EMBASE, and Cochrane library to identify eligible studies. Data were extracted and pooled into a meta-analysis. The primary outcomes were the symptomatic improvement, radiological changes, hypocalcemia rate, the requirement for vitamin D analogues, time to recurrence, recurrence, persistence, and reoperation rates of SPTX versus TPTX + AT. RESULTS A total of 18 studies with 3656 patients (1864 patients in SPTX and 1792 patients in TPTX + AT group) were included, and 15 studies were included in quantitative synthesis. No significant difference was observed in symptomatic improvement (93.3%, 89.0%; P = 0.99), radiological changes (85.4%, 85.3%; P = 0.91), hypocalcemia rate (16.6%, 18.1%; P = 0.29), persistence rate (6.1%, 2.0%; P = 0.16), time to recurrence (mean difference 1.46; P = 0.87), recurrence rate (9.2%, 7.1%; P = 0.76), and reoperation rate (5.3%, 5.8%; P = 0.66) between SPTX and TPTX + AT groups. Longer operative time (150 vs. 120 min), prolonged in-hospital stay (5.0 vs. 4.1 days), lower 1-month serum calcium level, and higher requirement for vitamin D analogues at 12 months were significantly observed in patients who underwent TPTX + AT compared to SPTX. CONCLUSIONS The two surgical approaches were both effective at controlling SHPT in clinical and laboratory terms. However, most of the data shown were not statistically significant. It was acceptable that surgeons chose either SPTX or TPTX + AT for SHPT.
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Affiliation(s)
- Qianqian Yuan
- Department of Thyroid and Breast Surgery, Zhongnan Hospital of Wuhan University, 169 Donghu Road, Wuhan, 430071, Hubei, People's Republic of China
| | - Yiqin Liao
- Department of Thyroid and Breast Surgery, Zhongnan Hospital of Wuhan University, 169 Donghu Road, Wuhan, 430071, Hubei, People's Republic of China
| | - Rui Zhou
- Department of Thyroid and Breast Surgery, Zhongnan Hospital of Wuhan University, 169 Donghu Road, Wuhan, 430071, Hubei, People's Republic of China
| | - Jiuyang Liu
- Department of Thyroid and Breast Surgery, Zhongnan Hospital of Wuhan University, 169 Donghu Road, Wuhan, 430071, Hubei, People's Republic of China
| | - Jianing Tang
- Department of Thyroid and Breast Surgery, Zhongnan Hospital of Wuhan University, 169 Donghu Road, Wuhan, 430071, Hubei, People's Republic of China
| | - Gaosong Wu
- Department of Thyroid and Breast Surgery, Zhongnan Hospital of Wuhan University, 169 Donghu Road, Wuhan, 430071, Hubei, People's Republic of China.
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Neves MCD, Rocha LAD, Cervantes O, Santos RO. Initial surgical results of 500 Parathyroidectomies for Hyperparathyroidism related to chronic kidney disease - mineral and bone disorder. ACTA ACUST UNITED AC 2018; 40:319-325. [PMID: 29944161 PMCID: PMC6534011 DOI: 10.1590/2175-8239-jbn-3924] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2017] [Accepted: 11/14/2017] [Indexed: 12/17/2022]
Abstract
Introduction: Surgical treatment of hyperparathyroidism related to chronic kidney disease
is a challenging procedure even for experienced parathyroid surgeons. Over
the years, adjuvant techniques have been developed to assist the medical
team to improve surgical outcomes. However, medical staff in poor countries
have less access to these techniques and the effectiveness of surgery in
this context is unclear. Objective: verify the effectiveness of surgery for treatment of hyperparathyroidism
related to chronic kidney disease without adjuvant techniques. Methods: Over a 5-years period, patients with hyperparathyroidism that had clinical
therapeutic failure were evaluated for surgical treatment. Total
parathyroidectomy with autograft or subtotal resection were the selected
procedures. Surgeries were performed in a tertiary hospital in Brazil
without the assistance of some of the adjuvant techniques that are usually
applied, such as frozen section, nerve monitoring, and gamma probe.
Intraoperative PTH and localization pre-operative exams were applied, but
with huge restrictions. Results: A total of 518 patients with hyperparathyroidism (128 secondary and 390
tertiary) were surgically treated. Total parathyroidectomy were performed in
81.5%, subtotal in 12.4%, and 61% of patients had a surgical failure. Of all
failures, only 1.4% needed a second surgery totaling 98.6% of successful
initial surgical treatment. Neck hematoma and unilateral focal fold
paralysis occurred in 1.9% and 1.5%, respectively. Conclusion: parathyroidectomy is a safe and reproducible surgical procedure even in the
absence of adjuvant techniques.
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Casella C, Galani A, Totaro L, Ministrini S, Lai S, Dimko M, Portolani N. Total Parathyroidectomy with Subcutaneous Parathyroid Forearm Autotransplantation in the Treatment of Secondary Hyperparathyroidism: A Single-Center Experience. Int J Endocrinol 2018; 2018:6065720. [PMID: 30123263 PMCID: PMC6079428 DOI: 10.1155/2018/6065720] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2018] [Accepted: 06/21/2018] [Indexed: 12/12/2022] Open
Abstract
INTRODUCTION Secondary hyperparathyroidism is common in chronic kidney disease. Parathyroidectomy is indicated in refractory hyperparathyroidism when medical treatments and so the parathyroid hormone levels cannot be lowered to acceptable values without causing significant hyperphosphatemia or hypercalcemia. The aim of this study is to compare the efficacy and safety of total parathyroidectomy with subcutaneous forearm autotransplantation with total parathyroidectomy with intramuscular forearm autotransplantation. MATERIALS AND METHODS A single-center retrospective cohort study of total parathyroidectomy with forearm autotransplantation from January 2002 to February 2013 was performed. According to the surgical technique, patients were divided into an intramuscular group (Group 1) and a subcutaneous group (Group 2). 38 patients with secondary hyperparathyroidism were enrolled; 23 patients were subjected to total parathyroidectomy with parathyroid tissue replanting in the subcutaneous forearm of the upper nondominant limb, while 15 patients were subjected to replanting in the intramuscular seat. RESULTS A total of 38 patients (56 ± 13 years) were enrolled. In both groups, the preoperative iPTH value was markedly high, 1750 ± 619 pg/ml in the intramuscular autotransplantation group and 1527 ± 451 pg/ml in the subcutaneous autotransplantation group (p = 0.079). Transient hypoparathyroidism was shown in 7 patients, and 1 patient showed persistent hypoparathyroidism (p = 0.387). 2 patients showed persistent hyperparathyroidism (p = 0.816), and in 2 others was found recurrent hyperparathyroidism (p = 0.816); 3 of them underwent autograftectomy. The anterior compartment of the forearm nondominant limb was sacrificed in 1 case of intramuscular autotransplantation with functional arm deficit. CONCLUSIONS The efficacy and safety of parathyroid tissue autotransplantation in the subcutaneous forearm of the upper nondominant limb is confirmed with a good rate of tissue engraftment and with a comparable number of postsurgical transient and persistent hypoparathyroidism and hyperparathyroidism incidence in both techniques. Furthermore, this technique preserves arm functionality in the case of autograftectomy. Consequently, it is our opinion that total parathyroidectomy with subcutaneous forearm autotransplantation is currently the best choice.
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Affiliation(s)
- Claudio Casella
- Department of Molecular and Translational Medicine, Surgical Clinic, University of Brescia, Brescia, Italy
| | - Alessandro Galani
- Department of Clinical and Experimental Sciences, Surgical Clinic, University of Brescia, Brescia, Italy
| | - Luigi Totaro
- Department of Clinical and Experimental Sciences, Surgical Clinic, University of Brescia, Brescia, Italy
| | - Silvia Ministrini
- Department of Clinical and Experimental Sciences, Surgical Clinic, University of Brescia, Brescia, Italy
| | - Silvia Lai
- Department of Clinical Medicine, Sapienza University of Rome, Rome, Italy
| | - Mira Dimko
- Nephrology and Dialysis Unit, ASST Carlo Poma, Mantova, Italy
| | - Nazario Portolani
- Department of Clinical and Experimental Sciences, Surgical Clinic, University of Brescia, Brescia, Italy
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Li JG, Xiao ZS, Hu XJ, Li Y, Zhang X, Zhang SZ, Shan AQ. Total parathyroidectomy with forearm auto-transplantation improves the quality of life and reduces the recurrence of secondary hyperparathyroidism in chronic kidney disease patients. Medicine (Baltimore) 2017; 96:e9050. [PMID: 29245308 PMCID: PMC5728923 DOI: 10.1097/md.0000000000009050] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Our study aims to explore the effect of total parathyroidectomy (PTX) with forearm autotransplantation (FAT) on the quality of life and recurrence of secondary hyperparathyroidism (SHPT) in chronic kidney disease patients. METHODS A total of 104 chronic kidney disease patients with SHPT were enrolled and divided into the PTX (n = 62) and PTX + FAT (n = 42) groups. The operation efficacy was evaluated by analyzing preoperative and postoperative values, including levels of intact parathyroid hormone (iPTH), serum phosphorus, serum calcium, alkaline phosphatase (ALP), calcium-phosphorus product, signs and symptoms, and MOS 36-item short-form health survey (SF-36) scores. Moreover, complications and recurrences were followed up for 12 months after the operation. Binary logistic regression was to present the risk factors for the recurrence of chronic kidney disease patients with SHPT. RESULTS Compared with the preoperative values, the PTX and PTX + FAT groups showed decrease postoperative levels of iPTH, serum phosphorus, serum calcium, calcium-phosphorus product, bone pain, and skin pruritus at all time periods. The PTX and PTX + FAT groups demonstrated decreased ALP, fracture or deformity, and coronary artery calcification at 1 month, decreased short stature at 3 months after the operation but increased SF-36 score after operation. Compared with the PTX group, the level of iPTH decreased and the levels of serum calcium, calcium-phosphorus product increased at 3, 6, and 12 months after the operation in the PTX + FAT group. The levels of ALP, fracture or deformity, short stature, and SF-36 decreased separately at 1 week and 6 and 12 months after the operation, along with the decrease of coronary artery calcification and the recurrence rate, respectively, at 6 and 12 months after the operation in the PTX + FAT group when compared with those in the PTX group. Logistic regression analysis evidenced that the preoperative iPTH level, SF-36 score, and operation type were the risk factors for the recurrence of chronic kidney disease with SHPT. CONCLUSION Total PTX combined with FAT is more effective in improving the quality of life and reducing the recurrence of chronic kidney disease with SHPT than PTX alone.
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Affiliation(s)
| | | | | | - Yun Li
- Department of Thyroid Breast Surgery
| | | | | | - Ai-Qin Shan
- Department of Nephrology, Yinzhou Hospital of Ningbo University Medical College, Ningbo, China
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Yuan H, Shi Y, Li Y, Yang L, Tang Y, Hu Z, Du R, Li X, Gu L, Wang H, Xi C, Tang C. Evaluation of a TPTX model induced by ischemia. Exp Anim 2017; 66:345-356. [PMID: 28674286 PMCID: PMC5682347 DOI: 10.1538/expanim.17-0029] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Parathyroidectomy (PTX), especially total parathyroidectomy (TPTX), is often recommended
for severe secondary hyperparathyroidism (SHPT) if other medical treatments fail. Accurate
identification and resection of parathyroid gland (PTG) tissue is the cornerstone of PTX.
The establishment of a rat TPTX model would be beneficial for several applications but
faces the same problems. In this experiment, we studied the mechanisms of ischemia for the
accurate identification and excision of PTG tissue to establish TPTX rat models and to
analyze the effects of surgical removal of PTG tissue as well as the effects of different
types of water intake in rats on clinical indices. We found that the ischemia method had
advantages when establishing a rat TPTX model. Removal of the PTG tissue resulted in
significantly changed postoperative indices, and varying the types of water intake induced
significant differences in these indices after removal of the PTG tissue. The absolute
value of the difference between the serum calcium and phosphorus concentrations (|Ca−P|)
accurately reflected the effect of removal of the PTG tissue and was superior to the
calcium-phosphorus product (Ca × P); Ca × P accurately reflected the effect of varying the
types of water intake in rats and was superior to the |Ca−P|.
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Affiliation(s)
- Haoran Yuan
- Department of General Surgery, The Fifth People's Hospital of Shanghai, Fudan University, 801 Heqing Road, Minhang District, Shanghai 200240, P.R. China
| | - Yongzhao Shi
- Department of General Surgery, The Fifth People's Hospital of Shanghai, Fudan University, 801 Heqing Road, Minhang District, Shanghai 200240, P.R. China
| | - Yinghua Li
- Central Laboratory, The Fifth People's Hospital of Shanghai, Fudan University, 801 Heqing Road, Minhang District, Shanghai 200240, P.R. China
| | - Lin Yang
- Department of Nephrology, The Fifth People's Hospital of Shanghai, Fudan University, 801 Heqing Road, Minhang District, Shanghai 200240, P.R. China
| | - Yan Tang
- Department of General Surgery, The Fifth People's Hospital of Shanghai, Fudan University, 801 Heqing Road, Minhang District, Shanghai 200240, P.R. China
| | - Zhiqing Hu
- Department of General Surgery, The Fifth People's Hospital of Shanghai, Fudan University, 801 Heqing Road, Minhang District, Shanghai 200240, P.R. China
| | - Ran Du
- Department of Oncology, The Fifth People's Hospital of Shanghai, Fudan University, 801 Heqing Road, Minhang District, Shanghai 200240, P.R. China
| | - Xueqing Li
- Department of General Surgery, The Fifth People's Hospital of Shanghai, Fudan University, 801 Heqing Road, Minhang District, Shanghai 200240, P.R. China
| | - Lingbin Gu
- Department of General Surgery, The Fifth People's Hospital of Shanghai, Fudan University, 801 Heqing Road, Minhang District, Shanghai 200240, P.R. China
| | - Hui Wang
- Department of General Surgery, The Fifth People's Hospital of Shanghai, Fudan University, 801 Heqing Road, Minhang District, Shanghai 200240, P.R. China
| | - Chenhui Xi
- Department of General Surgery, The Fifth People's Hospital of Shanghai, Fudan University, 801 Heqing Road, Minhang District, Shanghai 200240, P.R. China
| | - Chenghui Tang
- Department of General Surgery, The Fifth People's Hospital of Shanghai, Fudan University, 801 Heqing Road, Minhang District, Shanghai 200240, P.R. China
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Abruzzo A, Gioviale MC, Damiano G, Palumbo VD, Buscemi S, Lo Monte G, Gulotta L, Buscemi G, Lo Monte AI. Reoperation for persistent or recurrent secondary hyperparathyroidism. ACTA BIO-MEDICA : ATENEI PARMENSIS 2017; 88:325-328. [PMID: 29083339 DOI: 10.23750/abm.v88i3.4722] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 08/06/2015] [Accepted: 01/21/2016] [Indexed: 12/15/2022]
Abstract
BACKGROUND Secondary hyperparathyroidism is a common acquired disorder seen in chronic renal failure. Its pathophysiology is mainly due to hyperphosphatemia and vitamin D deficiency and resistance. When medical treatment fails, subtotal and total parathyroidectomy with autotransplantation are the standard procedures, although both are associated with high recurrence rates. METHODS AND RESULTS 4 patients experienced persistence and 9 relapse. The first 4 were subjected to reoperation after 6 months for the persistence of symptoms due to the finding of a supernumerary adenomatous gland while the remaining patients at the reoperation showed in 5 cases 2 more glands in over thymic position, and 4 an hyperplasia of the residual glandular tissue. A classic cervicotomy was sufficient to remove the residual parathyroid in patients with persistent hyperparathyroidism. For cases of recurrent hyperparathyroidism it was enough a medial approach and sometimes lateral for the complete excision of the hyperplastic tissue. The advent of the intraoperative technique of parathyroid hormone dosage allowed a better performance of the surgical technique for the last 3 patients undergoing reoperation. After reoperation all patients had immediate regression of clinical symptoms with normalization of serum calcium and PTH levels. CONCLUSIONS On the basis of these considerations, diagnostic imaging has a not negligible role because during the first intervention helps to have an idea of the possible location of the glands and thus to avoid the risk of recurrence and relapse due to ectopic or supernumerary tissue.
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13
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Qi HJ, Yang WW, Zhang LD, Shi XJ, Li QY, Ye T. Peripherally inserted central catheters for calcium requirements after successful parathyroidectomy: a comparison with centrally inserted catheters. Ann R Coll Surg Engl 2017; 99:358-362. [PMID: 28462656 PMCID: PMC5449693 DOI: 10.1308/rcsann.2017.0004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/02/2016] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Intravenous calcium supplements are often required following parathyroidectomy to avoid postoperative hypocalcaemia. The aim of this study was to compare application effect of a femoral central venous catheter (CVC) and peripherally inserted central catheter (PICC) on intravenous calcium supplements after parathyroidectomy. METHODS We retrospectively reviewed the hospital records of 73 patients with secondary hyperparathyroidism who underwent a successful parathyroidectomy at the Huashan Hospital attached to Fudan University between 1 April 2011 and 1 February 2016. RESULTS Of the 73 study participants, 39 (53.4%) had a PICC and 34 (46.6%) had a CVC, respectively. Patients in the CVC group needed 6-7 days of intravenous calcium supplements, while patients in PICC group needed only 2-3 days to achieve normal serum calcium concentration (2.2-2.6 mmol/L). Furthermore, the duration of calcium supplementation was 71.62 ± 4.48 hours in PICC group and 100.4 ± 5.43 hours in CVC group (P < 0.05). Of the patients in PICC group, the incidence of catheter occlusion, operation failure and hypocalcaemia was 0%, which was significantly lower than those in CVC group (2.56%, 7.69% and 7.69%, respectively). CONCLUSIONS PICC is a safe and efficient alternative in contrast to CVC for providing venous access for calcium supplementation in surgical patients after parathyroidectomy.
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Affiliation(s)
- H J Qi
- Clinical Pharmacy Laboratory, Huashan Hospital North, Fudan University , Shanghai , China
| | - W W Yang
- General Surgery Unit, Huashan Hospital, Fudan University , Shanghai , China
| | - L D Zhang
- Clinical Pharmacy Laboratory, Huashan Hospital North, Fudan University , Shanghai , China
| | - X J Shi
- Clinical Pharmacy Laboratory, Huashan Hospital North, Fudan University , Shanghai , China
| | - Q Y Li
- Clinical Pharmacy Laboratory, Huashan Hospital North, Fudan University , Shanghai , China
| | - T Ye
- Clinical Pharmacy Laboratory, Huashan Hospital North, Fudan University , Shanghai , China
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14
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Polistena A, Sanguinetti A, Lucchini R, Galasse S, Avenia S, Monacelli M, Johnson LB, Jeppsson B, Avenia N. Surgical treatment of secondary hyperparathyroidism in elderly patients: an institutional experience. Aging Clin Exp Res 2017; 29:23-28. [PMID: 27830521 DOI: 10.1007/s40520-016-0669-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2016] [Accepted: 11/01/2016] [Indexed: 12/30/2022]
Abstract
BACKGROUND Secondary hyperparathyroidism in elderly fragile patients presents clinical difficulties due to severity of symptoms and related comorbidity. The optimal surgical approach for this group of patients is still debated. AIM The aim of the study was to define the optimal technique of parathyroidectomy in elderly patients with secondary hyperparathyroidism. METHODS Retrospective analysis in a series of 253 patients including 35 elderly individuals at a single institution was carried out. Postoperative parathyroid hormone decrease, surgical complications and symptoms control were analyzed for all patients in relation to the types of parathyroidectomy performed. RESULTS In elderly patients, total parathyroidectomy was the most used approach. Subtotal parathyroidectomy was mostly reserved for younger patients suitable for kidney transplantation. No elderly patients treated with total parathyroidectomy were autotransplanted. No significant difference in surgical complications was observed between younger and elderly patients and considering the different procedures. Adequate symptom control after surgery was achieved in almost 90% of patients. A limited rate of recurrence requiring repeat surgery was observed only after subtotal parathyroidectomy. DISCUSSION Considering the features of all types of parathyroidectomy, very low recurrence rate, contained postoperative hypocalcemia and limited complications following total parathyroidectomy, might represent specific advantages for elderly patients. CONCLUSIONS Total parathyroidectomy without parathyroid transplantation is safe for elderly patients with secondary hyperparathyroidism and a good alternative to the well-established total parathyroidectomy with autografting.
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Affiliation(s)
- Andrea Polistena
- UOC Chirurgia Generale e Specialità Chirurgiche, Endocrine Surgery Unit, Medical School, S. Maria University Hospital, University of Perugia, via Tristano di Joannuccio 1, 05100, Terni, Italy.
| | - Alessandro Sanguinetti
- UOC Chirurgia Generale e Specialità Chirurgiche, Endocrine Surgery Unit, Medical School, S. Maria University Hospital, University of Perugia, via Tristano di Joannuccio 1, 05100, Terni, Italy
| | - Roberta Lucchini
- UOC Chirurgia Generale e Specialità Chirurgiche, Endocrine Surgery Unit, Medical School, S. Maria University Hospital, University of Perugia, via Tristano di Joannuccio 1, 05100, Terni, Italy
| | - Segio Galasse
- UOC Chirurgia Generale e Specialità Chirurgiche, Endocrine Surgery Unit, Medical School, S. Maria University Hospital, University of Perugia, via Tristano di Joannuccio 1, 05100, Terni, Italy
| | - Stefano Avenia
- UOC Chirurgia Generale e Specialità Chirurgiche, Endocrine Surgery Unit, Medical School, S. Maria University Hospital, University of Perugia, via Tristano di Joannuccio 1, 05100, Terni, Italy
| | - Massimo Monacelli
- UOC Chirurgia Generale e Specialità Chirurgiche, Endocrine Surgery Unit, Medical School, S. Maria University Hospital, University of Perugia, via Tristano di Joannuccio 1, 05100, Terni, Italy
| | - Louis Banka Johnson
- Surgical Department, Skåne University Hospital, University of Lund, Malmö, Sweden
| | - Bengt Jeppsson
- Surgical Department, Skåne University Hospital, University of Lund, Malmö, Sweden
| | - Nicola Avenia
- UOC Chirurgia Generale e Specialità Chirurgiche, Endocrine Surgery Unit, Medical School, S. Maria University Hospital, University of Perugia, via Tristano di Joannuccio 1, 05100, Terni, Italy
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15
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Abruzzo A, Gioviale MC, Damiano G, Palumbo VD, Buscemi S, Monte GL, Gulotta L, Buscemi G, Monte AIL. Reoperation for persistent or recurrent secondary hyperparathyroidism. ACTA BIO-MEDICA : ATENEI PARMENSIS 2017; 88. [PMID: 29083339 PMCID: PMC6142843 DOI: 10.23750/abm.v%vi%i.4722] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND Secondary hyperparathyroidism is a common acquired disorder seen in chronic renal failure. Its pathophysiology is mainly due to hyperphosphatemia and vitamin D deficiency and resistance. When medical treatment fails, subtotal and total parathyroidectomy with autotransplantation are the standard procedures, although both are associated with high recurrence rates. METHODS AND RESULTS 4 patients experienced persistence and 9 relapse. The first 4 were subjected to reoperation after 6 months for the persistence of symptoms due to the finding of a supernumerary adenomatous gland while the remaining patients at the reoperation showed in 5 cases 2 more glands in over thymic position, and 4 an hyperplasia of the residual glandular tissue. A classic cervicotomy was sufficient to remove the residual parathyroid in patients with persistent hyperparathyroidism. For cases of recurrent hyperparathyroidism it was enough a medial approach and sometimes lateral for the complete excision of the hyperplastic tissue. The advent of the intraoperative technique of parathyroid hormone dosage allowed a better performance of the surgical technique for the last 3 patients undergoing reoperation. After reoperation all patients had immediate regression of clinical symptoms with normalization of serum calcium and PTH levels. CONCLUSIONS On the basis of these considerations, diagnostic imaging has a not negligible role because during the first intervention helps to have an idea of the possible location of the glands and thus to avoid the risk of recurrence and relapse due to ectopic or supernumerary tissue.
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Affiliation(s)
- Alida Abruzzo
- Phd School in Surgical Biotechnology and Regenerative Medicine. School of Medicine – University of Palermo, Italy
| | | | - Giuseppe Damiano
- AOUP - P. Giaccone - School of Medicine, University of Palermo, Italy
| | - Vincenzo Davide Palumbo
- AOUP - P. Giaccone - School of Medicine, University of Palermo, Italy,Euro-Mediterranean Institute of Science and Technology (IEMEST), Palermo, Italy
| | | | | | - Leonardo Gulotta
- Department of General Surgery, Urgency and Organ Transplantation, University of Palermo, Italy
| | - Giuseppe Buscemi
- DICHIRONS Department, School of Medicine, University of Palermo, Italy,AOUP - P. Giaccone - School of Medicine, University of Palermo, Italy
| | - Attilio Ignazio Lo Monte
- DICHIRONS Department, School of Medicine, University of Palermo, Italy,AOUP - P. Giaccone - School of Medicine, University of Palermo, Italy,Correspondance: Prof. Attilio Ignazio Lo Monte DICHIRONS Department, Faculty of Medicine University of Palermo, Italy Tel. +39-091-6553743 E-mail:
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16
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Ivarsson KM, Akaberi S, Isaksson E, Reihnér E, Rylance R, Prütz KG, Clyne N, Almquist M. The effect of parathyroidectomy on patient survival in secondary hyperparathyroidism. Nephrol Dial Transplant 2015; 30:2027-33. [PMID: 26374600 PMCID: PMC4832998 DOI: 10.1093/ndt/gfv334] [Citation(s) in RCA: 59] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2015] [Revised: 08/18/2015] [Accepted: 08/18/2015] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Secondary hyperparathyroidism is a common condition in patients with end-stage renal disease and is associated with osteoporosis and cardiovascular disease. Despite improved medical treatment, parathyroidectomy (PTX) is still necessary for many patients on renal replacement therapy. The aim of this study was to evaluate the effect of PTX on patient survival. METHODS A nested index-referent study was performed within the Swedish Renal Registry (SRR). Patients on maintenance dialysis and transplantation at the time of PTX were analysed separately. The PTX patients in each of these strata were matched for age, sex and underlying renal diseases with up to five referent patients who had not undergone PTX. To calculate survival time and hazard ratios, indexes and referents were assigned the calendar date (d) of the PTX of the index patient. The risk of death after PTX was calculated using crude and adjusted Cox proportional hazards regressions. RESULTS There were 20 056 patients in the SRR between 1991 and 2009. Of these, 579 (423 on dialysis and 156 with a renal transplant at d) incident patients with PTX were matched with 1234/892 non-PTX patients. The adjusted relative risk of death was a hazard ratio (HR) of 0.80 [95% confidence interval (CI) 0.65-0.99] for dialysis patients at d who had undergone PTX compared with matched patients who had not. Corresponding results for the patients with a renal allograft at d were an HR of 1.10 (95% CI 0.71-1.70). CONCLUSIONS PTX was associated with improved survival in patients on maintenance dialysis but not in patients with renal allograft.
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Affiliation(s)
| | - Shahriar Akaberi
- Department of Nephrology and Transplantation, Skane University Hospital Lund, Skåne, Sweden
| | | | - Eva Reihnér
- Department of Molecular Medicine and Surgery, Karolinska University Hospital, Stockholm, Sweden
| | - Rebecca Rylance
- National Registry Centre, Skane University Hospital Lund, Skåne, Sweden
| | - Karl-Göran Prütz
- Department of Internal Medicine, Helsingborg Hospital, Helsingborg, Sweden
| | - Naomi Clyne
- Department of Nephrology and Transplantation, Skane University Hospital Lund, Skåne, Sweden
| | - Martin Almquist
- Department of Surgery Section of Endocrine and Sarcoma, Skane University Hospital, Lund, Skåne, Sweden
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17
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Rajeev P, Lee KY, Tang XJ, Goo TT, Tan WB, Ngiam KY. Outcomes of parathyroidectomy in renal hyperparathyroidism in patients with No access to renal transplantation in Singapore. Int J Surg 2015; 25:64-8. [PMID: 26612524 DOI: 10.1016/j.ijsu.2015.11.005] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2015] [Revised: 10/27/2015] [Accepted: 11/05/2015] [Indexed: 12/01/2022]
Abstract
BACKGROUND Total parathyroidectomy with autotransplantation (TPTX + AT) and subtotal parathyroidectomy (SPTX) are considered standard surgical treatments for refractory renal hyperparathyroidism. However, there is little data available comparing their outcomes in an area with poor access to renal transplant and calcimimetics. METHODS Patients with renal hyperparathyroidism who underwent TPTX + AT and SPTX in a tertiary institution from 2006 to 2013 were studied. Patient characteristics, pre- and post-operative biochemical marker levels, and outcomes including recurrence rates, post-operative morbidity and mortality were analysed. RESULTS 87 patients underwent parathyroidectomy for renal hyperthyroidism. Transplant patients were excluded in this study. 81 patients were on long-term dialysis, with a median time of 7 years from initiation of haemodialysis to parathyroidectomy. 57 patients (70.4%) underwent TPTX + AT while 24 (29.6%) underwent SPTX. Post-operatively, there was significant decrease in parathyroid hormone (PTH), calcium and phosphate levels in both groups. PTH and phosphate levels were significantly lowered with TPTX compared to SPTX (p = 0.004, 0.003). Symptomatic hypocalcaemia was seen in both groups. In a median follow-up of 4 years, 11 patients developed biochemical recurrence, with a median time of 29 months to recurrence. Median PTH at recurrence was 67.1 pmol/L. Rate of recurrence was higher in patients who underwent SPTX (20.8% vs 10.5%), with a shorter median time to recurrence (median 62.1 vs 81.3 months). 2 patients required resection of the autograft. Cohort mortality was 11 patients (13.4%), with 3 deaths secondary to cardiovascular events. CONCLUSION Total parathyroidectomy with autoimplantation is superior to subtotal parathyroidectomy in the short to intermediate term.
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Affiliation(s)
- Parameswaran Rajeev
- Endocrine Surgical Unit, Department of Surgery, University Surgical Cluster, BNational University Hospital, Singapore
| | - Kai Yin Lee
- Endocrine Surgical Unit, Department of Surgery, University Surgical Cluster, BNational University Hospital, Singapore
| | - Xin Jie Tang
- Endocrine Surgical Unit, Department of Surgery, University Surgical Cluster, BNational University Hospital, Singapore
| | - Tiong Thye Goo
- Endocrine Surgical Unit, Department of Surgery, University Surgical Cluster, BNational University Hospital, Singapore
| | - Wee Boon Tan
- Endocrine Surgical Unit, Department of Surgery, University Surgical Cluster, BNational University Hospital, Singapore
| | - Kee Yuan Ngiam
- Endocrine Surgical Unit, Department of Surgery, University Surgical Cluster, BNational University Hospital, Singapore.
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Jing Y, Zhao H, Ge Y, Jia F, He Q, Wang S, Meng J. Application of total parathyroidectomy with auto-transplantation for uremia secondary hyperparathyroidism treatment. Int J Clin Exp Med 2015; 8:11188-11194. [PMID: 26379922 PMCID: PMC4565305] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2015] [Accepted: 07/12/2015] [Indexed: 06/05/2023]
Abstract
BACKGROUND Secondary hyperparathyroidism (sHPT) is a common acquired disorder in patients with chronic renal failure. Despite the development of new therapeutic agents, a majority of patients will require parathyroidectomy. The aim of this study was to evaluate total parathyroidectomy with auto-transplantation of trace amounts of parathyroid tissue as a surgical option in uremia sHPT treatment. METHODS Clinical data of 50 sHPT patients who underwent total parathyroidectomy with auto-transplantation between January 2011 and December 2013 were reviewed retrospectively. Symptoms such as bone pain and fractures, concentrations of intact parathyroid hormone (iPTH), levels of ionized calcium and serum phosphorus, and activity of alkaline phosphatase were recorded before and after parathyroidectomy. RESULTS After operation, signs of pruritus, bone pain and muscle weakness was disappeared, iPTH level and serum phosphate concentration were declined markedly. No serious postoperative complications were observed. Follow-up observation was around 28 months. One female patient (2%) died 3 months after surgery due to heart failure, and another patient (2%) had persistent disease. All other patients recovered during the follow-up period. CONCLUSIONS Total parathyroidectomy with auto-transplantation of trace amounts of parathyroid tissue was considered to be a feasible, safe and effective surgical option for the treatment of sHPT.
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Affiliation(s)
- Ying Jing
- Department of Blood Purification, General Hospital of Jinan Military Command of The PLANo. 25 Shifan Road, Jinan, Shandong, 250031, People’s Republic of China
| | - Hanhui Zhao
- Department of Blood Purification, General Hospital of Jinan Military Command of The PLANo. 25 Shifan Road, Jinan, Shandong, 250031, People’s Republic of China
| | - Yanming Ge
- Department of Blood Purification, General Hospital of Jinan Military Command of The PLANo. 25 Shifan Road, Jinan, Shandong, 250031, People’s Republic of China
| | - Fengyu Jia
- Department of Blood Purification, General Hospital of Jinan Military Command of The PLANo. 25 Shifan Road, Jinan, Shandong, 250031, People’s Republic of China
| | - Qingqing He
- Department of Thyroid and Breast Surgery, General Hospital of Jinan Military Command of The PLANo. 25 Shifan Road, Jinan, Shandong, 250031, People’s Republic of China
| | - Suxia Wang
- Department of Blood Purification, General Hospital of Jinan Military Command of The PLANo. 25 Shifan Road, Jinan, Shandong, 250031, People’s Republic of China
| | - Jianzhong Meng
- Department of Blood Purification, General Hospital of Jinan Military Command of The PLANo. 25 Shifan Road, Jinan, Shandong, 250031, People’s Republic of China
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