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No Need to Abandon Focused Unilateral Exploration for Primary Hyperparathyroidism with Intraoperative Monitoring of Intact Parathyroid Hormone: A Ten Year Follow-Up
*Jovian Yu1, *Kristopher Day2, *Bella Avanessian2, Jack Monchik2
1The Warren Alpert Medical School of Brown University, Providence, RI;2Rhode Island Hospital, Providence, RI
Objective:
To investigate the rate of recurrent hyperparathyroidism (RHP) after unilateral parathyroidectomy, in order to determine the safety and efficacy of unilateral parathyroidectomy with intraoperative monitoring of intact parathyroid hormone (IOPTH) for patients with preoperative localization.
Design:
Retrospective cohort study.
Setting:
Rhode Island Hospital, a private, not-for-profit, academic, tertiary referral medical center.
Patients:
872 patients who underwent parathyroidectomy by a single surgeon for non-recurrent primary hyperparathyroidism from January 2003 to September 2013. 564 patients with at least one positive preoperative localization study underwent focused unilateral exploration with IOPTH that decreased >50% from the highest intraoperative level after 5 or 10 minutes post-resection. Patients excluded were those with multiple endocrine neoplasia, previous parathyroid surgery outside of the study period, mediastinal tumors requiring thoracotomy.
Interventions:
Main Outcome Measures:
Rate of recurrent hyperparathyroidism.
Results:
Eight patients (1.4%) required reoperation for recurrent HP (RHP). Average time interval between operations was 3.2 years, ranging 3-104 months. Correlation of preoperative localization tests with IOPTH for patients without recurrence for ultrasound (US), sestamibi (STS), and US and STS combined were 74.3% (n = 413), 86.9% (n = 483), and 71.4% (n = 397). These rates did not significantly differ from RHP by the Fischer’s exact test comparison (p = 0.99, p = 0.6, p = 0.99, respectively).
Conclusions:
We should not abandon the focused unilateral approach for the subset of PHP patients with a positive localization and an appropriate fall in IOPTH, as there is a very low rate of recurrence.
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