New England Surgical Society

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Subtotal Parathyroidectomy Versus Total Parathyroidectomy With Autotransplantation for Secondary Hyperparathyroidism in Dialysis Patients: Short and Long Term Outcomes
*Polina Zmijewski1, *Jonathan Staloff2, *Madeline Wozniak1, Peter J Mazzaglia1
1Rhode Island Hospital, Providence, RI;2Alpert School of Medicine, Providence, RI

Objective:Compare the immediate and long- term outcomes of subtotal parathyroidectomy (SPTX) vs. total parathyroidectomy with autotransplantation (TPTX-AT) for dialysis patients with secondary hyperparathyroidism
Design:Retrospective review
Setting: 719 bed tertiary care academic medical center
Patients: 48 dialysis patients undergoing parathyroidectomy between 2006 and 2017
Interventions: 25 had SPTX and 23 had TPTX-AT
Main Outcome Measures: Post- operative day 1 calcium and PTH, hospital length of stay, duration and severity of postoperative hypocalcemia, and reoperation for recurrence, long term hypoparathyroidism
Results: Pre-operative age, calcium and PTH were similar. Post- op day 1 calcium and PTH values were 8.31 and 31.548.9 for SPTX, and 8.11.3 and 16.525.3 for TPTX-AT (p>.05). Hospital length of stay was 2.21.6 days for SPTX and 3.23 days for TPTX-AT (p=.07). Total gland weight submitted to pathology was 1.9971.6 gm for SPTX and 4.435.19 gm for TPTX. The required doses of calcium and calcitriol at discharge did not significantly differ. Most recent PTH > 6 months post-op was 99.8103 for SPTX and 48.164 for TPTX-AT (p=.02), and simultaneous calcium was 8.91.7 for SPTX and 8.51.9 for TPTX-AT (p=.6). Re-operation for recurrence was required in 3 SPTX and no TPTX-AT. PTH values< 15 at long term follow up occurred in 12% of SPTX and 47.8% of TPTX-AT. Long term serum calcium value < 8 occurred in 8% of SPTX and 47.8% of TPTX-AT.
Conclusions: In dialysis patients undergoing parathyroidectomy, both SPTX and TPTX-AT are curative. The long- term control of PTH elevation and avoidance of recurrent disease is improved with TPTX-AT, but comes at the expense of longer length of stay and higher risk of long- term hypoparathyroidism requiring calcium and calcitriol supplementation.


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