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2016 ; 401
(7
): 965-974
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Subtotal parathyroidectomy for secondary renal hyperparathyroidism: a 20-year
surgical outcome study
#MMPMID27233241
Konturek A
; Barczy?ski M
; Stopa M
; Nowak W
Langenbecks Arch Surg
2016[Nov]; 401
(7
): 965-974
PMID27233241
show ga
AIM: The aim of this study was to evaluate the outcomes of surgery for patients
with secondary renal hyperparathyroidism (rHPT). METHODS: This is a retrospective
cohort study. Our institutional database was searched for eligible patients
treated in 1995-2014. The inclusion criterion was initial parathyroidectomy for
rHPT. Clinical and follow-up data were analyzed to estimate the cure rate
(primary outcome), and morbidity (secondary outcome). RESULTS: The study group
comprised 297 patients (154 females, age 44.5?±?13.7 years, follow-up
24.6?±?10.5 months), including 268 (90.2 %) patients who had underwent subtotal
parathyroidectomy, and 29 (9.8 %) who had had incomplete parathyroidectomy.
Intraoperative iPTH assay was utilized in 207 (69.7 %) explorations. Persistent
rHPT occurred in 12/268 (4.5 %) patients after subtotal parathyroidectomy and
5/29 (17.2 %) subjects after incomplete parathyroidectomy (p?=?0.005). The
patients operated on with intraoperative iPTH assay had a higher cure rate than
non-monitored individuals, 201/207 (97.1 %) vs. 79/90 (87.8 %), respectively
(p?=?0.001). In-hospital mortality occurred in 1/297 (0.3 %) patient. The hungry
bone syndrome occurred in 84/268 (31.3 %) patients after subtotal
parathyroidectomy and 2/29 (6.9 %) subjects after incomplete parathyroidectomy
(p?=?0.006). Transient recurrent laryngeal nerve paresis occurred in 14/594
(2.4 %) and permanent in 5/594 (0.8 %) nerves at risk. CONCLUSIONS: Subtotal
parathyroidectomy is a safe and efficacious treatment for patients with rHPT.
Utilization of intraoperative iPTH assay can guide surgical exploration and
improve the cure rate.