Total Parathyroidectomy Without Autotransplantation for Secondary Hyperparathyroidism
- 29 October 2008
- journal article
- research article
- Published by Wiley in World Journal of Surgery
- Vol. 33 (2), 248-254
- https://doi.org/10.1007/s00268-008-9765-8
Abstract
Background To treat secondary hyperparathyroidism with subtotal parathyroidectomy or total parathyroidectomy with autotransplantation might cause the disease to recur because of growth of the parathyroid remnant or the autografts. The aim of the present study was to determinate an alternative surgical treatment for secondary hyperparathyroidism. Methods Of 94 uremic patients, 44 (median age: 50.5 years; 33 women/11 men) were assigned to group A, patients who were not expected to receive kidney transplantation for various reasons and had total parathyroidectomy without autotransplantation; 50 (median age 46 years; 33 women/17 men) were assigned to group B, patients who had either total parathyroidectomy with autotransplantation or subtotal total parathyroidectomy with preservation of parathyroid tissue in situ. Parameters measured included demographics, perioperative and follow-up biochemistry tests, operative time, postoperative complications, length of hospital stay, patients’ compliance with the postoperative calcium and 1,25 dihydroxy-viatmin D supplementation regimen, symptom relief, and presence of recurrence. Results Mean operative times were 103 and 122 min (P = 0.007); postoperative complication rates were 18.2% and 12.0% (P = 0.563); mean hospital stays were 6 and 9 days (P = 0.259); adequate patient compliance with the postoperative calcium and 1,25 dihydroxy-viatmin D regimens were 84.1% and 78.0%, respectively (P = 0.6); symptom relief rates were 88.6% and 80.0% (P = 0.277). Recurrence rates over 60 months in group A and group B were 4.5% and 18.0%, resectively (P = 0.028 by Kaplan-Meier analysis). Conclusions Because of the lower recurrent rate and shorter operative time, total parathyroidectomy without autotransplantation may be an option for treating patients with symptomatic secondary hyperparathyroidism who are not expected to receive kidney transplantation.This publication has 17 references indexed in Scilit:
- Total Parathyroidectomy Without Autotransplantation for Renal Hyperparathyroidism: Experience with a qPTH‐controlled ProtocolWorld Journal of Surgery, 2006
- Four gland parathyroidectomy without reimplantation in patients with chronic renal failurePublished by Oxford University Press (OUP) ,2005
- Surgical Indications and Procedures of Parathyroidectomy in Patients with Chronic Kidney DiseaseTherapeutic Apheresis and Dialysis, 2005
- Secondary and Tertiary Hyperparathyroidism: Causes of Recurrent Disease After 446 ParathyroidectomiesAnnals of Surgery, 2001
- Short- and long-term outcome of total parathyroidectomy with immediate autografting versus subtotal parathyroidectomy in patients with end-stage renal disease.American Journal of Nephrology, 1999
- Clinical course after total parathyroidectomy without autotransplantation in patients with end-stage renal failureAmerican Journal of Kidney Diseases, 1999
- Combined report on regular dialysis and transplantation in Europe, XX, 1989.1991
- Results of reoperations for persistent or recurrent secondary hyperparathyroidism in hemodialysis patientsWorld Journal of Surgery, 1990
- Total parathyroidectomy in treatment of secondary (renal) hyperparathyroidism.BMJ, 1967
- ELECTIVE SUBTOTAL PARATHYROIDECTOMY FOR RENAL HYPERPARATHYROIDISMThe Lancet, 1960