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Focused Versus Bilateral Parathyroid Exploration for Primary Hyperparathyroidism: A Systematic Review and Meta-analysis

  • Endocrine Tumors
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

ABSTRACT

Background

Focused exploration (FE) and bilateral parathyroid exploration (BE) are the standard surgical options for patients with primary hyperparathyroidism. However, the relative risk of recurrence, persistence, overall failure, reoperation, and any complications associated with either surgical approach is unclear. This study compared the outcomes and complication rates after FE and BE for patients with primary hyperparathyroidism.

Methods

PubMed and Embase were searched for studies comparing these outcomes between FE and BE. A meta-analysis was performed using RevMan 5.3 software. Published data were pooled using the DerSimonian random-effect model, and results were presented as odds ratio (OR) or mean difference with 95% confidence interval (CI).

Results

A total of 12,743 patients from 19 studies were included in this meta-analysis. In comparison with BE, the FE arm had comparable rates of recurrence (OR 1.08; 95% CI 0.59–2.00; p = 0.80; n = 9 studies), persistence (OR 0.89; 95% CI 0.58–1.35; p = 0.58; n = 13), overall failure (OR 0.88; 95% CI 0.58–1.34; p = 0.56; n = 13), and reoperation (OR 1.05; 95% CI 0.25–4.32; p = 0.95, n = 4). The operative time was significantly shorter (mean difference = −39.86; 95% CI −53.05 to −26.84; p < 0.01, n = 9), with a lower overall complication rate in the FE arm (OR  0.35; 95% CI 0.15–0.84; p = 0.02; n = 12). The latter was attributed predominantly to a lower risk of transient hypocalcemia (OR  0.36; 95% CI 0.14–0.90; p = 0.03; n = 9). There was a significant heterogeneity among these studies for all outcomes except for disease recurrence.

Conclusions

Compared with BE, FE has similar recurrence, persistence, and reoperation rates but significantly lower overall complication rates and shorter operative time.

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REFERENCES

  1. Hodin R, Angelos P, Carty S, et al. No need to abandon unilateral parathyroid surgery. J Am Coll Surg. 2012;215:297.

    Article  PubMed  Google Scholar 

  2. Siperstein A, Berber E, Barbosa GF, et al. Predicting the success of limited exploration for primary hyperparathyroidism using ultrasound, sestamibi, and intraoperative parathyroid hormone: analysis of 1158 cases. Ann Surg. 2008;248:420–8.

    PubMed  Google Scholar 

  3. Norman J, Lopez J, Politz D. Abandoning unilateral parathyroidectomy: why we reversed our position after 15,000 parathyroid operations. J Am Coll Surg. 2012;214:260–9.

    Article  PubMed  Google Scholar 

  4. Noureldine SI, Gooi Z, Tufano RP. Minimally invasive parathyroid surgery. Gland Surg. 2015;4:410–9.

    PubMed  PubMed Central  Google Scholar 

  5. Chen H, Sokoll LJ, Udelsman R. Outpatient minimally invasive parathyroidectomy: a combination of sestamibi-SPECT localization, cervical block anesthesia, and intraoperative parathyroid hormone assay. Surgery. 1999;126:1012–6.

    Google Scholar 

  6. Norman J, Chheda H, Farrell C. Minimally invasive parathyroidectomy for primary hyperparathyroidism: decreasing operative time and potential complications while improving cosmetic results. Am Surg. 1998;64:391–6.

    CAS  PubMed  Google Scholar 

  7. Lowney JK, Weber B, Johnson S, Doherty GM. Minimal incision parathyroidectomy: cure, cosmesis, and cost. World J Surg. 2000;24:1442–5.

    Article  CAS  PubMed  Google Scholar 

  8. O’Leary DP, Clover AJ, Galbraith JG, Mushtaq M, Shafiq A, Redmond HP. Adhesive strip wound closure after thyroidectomy/parathyroidectomy: a prospective randomized controlled trial. Surgery. 2016;153:408–12.

    Article  Google Scholar 

  9. Bergenfelz A, Lindblom P, Tibblin S, Westerdahl J. Unilateral versus bilateral neck exploration for primary hyperparathyroidism: a prospective randomized controlled trial. Ann Surg. 2002;236:543–51.

    Article  PubMed  PubMed Central  Google Scholar 

  10. Schneider DF, Mazeh H, Chen H, Sippel RS. Predictors of recurrence in primary hyperparathyroidism: an analysis of 1386 cases. Ann Surg. 2014;259:563–8.

    Article  PubMed  PubMed Central  Google Scholar 

  11. Udelsman R. Six hundred fifty-six consecutive explorations for primary hyperparathyroidism. Ann Surg. 2002;235:665–70.

    Article  PubMed  PubMed Central  Google Scholar 

  12. Moher D, Liberati A, Tetzlaff J, Altman DG. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. J Clin Epidemiol. 2009;62:1006–12.

    Article  PubMed  Google Scholar 

  13. DerSimonian R, Laird N. Meta-analysis in clinical trials. Control Clin Trials. 1986;7:177–88.

    Article  CAS  PubMed  Google Scholar 

  14. Norlén O, Wang KC, Tay YK, et al. No need to abandon focused parathyroidectomy. Ann Surg. 2015;261:991–6.

    Article  PubMed  Google Scholar 

  15. Bergenfelz A, Kamigiesser V, Zielke A Nies C, Rothmund M. Conventional bilateral cervical exploration versus open minimally invasive parathyroidectomy under local anaesthesia for primary hyperparathyroidism. Br J Surg. 2005;92:190–7.

    Article  CAS  PubMed  Google Scholar 

  16. Beyer TD, Solorzano CC, Starr F, Nilubol N, Prinz RA. Parathyroidectomy outcomes according to operative approach. Am J Surg. 2007;193:368–72.

    Article  PubMed  Google Scholar 

  17. Irvin GL, Carneiro DM, Solorzano CC. Progress in the operative management of sporadic primary hyperparathyroidism over 34 years. Ann Surg. 2004;239:704–8.

    Article  PubMed  PubMed Central  Google Scholar 

  18. Grant CS, Thompson G, Farley D, van Heerden J.. Primary hyperparathyroidism surgical management since the introduction of minimally invasive parathyroidectomy. Arch Surg. 2005;140:472–8.

    Article  PubMed  Google Scholar 

  19. Karakas E, Schneider R, Rothmund M, Bartsch DK, Schlosser K. Initial surgery for benign primary hyperparathyroidism: an analysis of 1,300 patients in a teaching hospital. World J Surg. 2014;38:2011–8.

    Article  PubMed  Google Scholar 

  20. Hughes DT, Miller BS, Park PB, Cohen MS, Doherty GM, Gauger PG. Factors in conversion from minimally invasive parathyroidectomy to bilateral parathyroid exploration for primary hyperparathyroidism. Surgery. 2015;154:1428–35.

    Article  Google Scholar 

  21. Bagul A, Patel HP, Chadwick D, Harrison BJ, Balasubramanian SP. Primary hyperparathyroidism: an analysis of failure of parathyroidectomy. World J Surg. 2014;38:534–41.

    Article  CAS  PubMed  Google Scholar 

  22. Slepavicius A, Beisa V, Janusonis V, Strupas K. Focused versus conventional parathyroidectomy for primary hyperparathyroidism: a prospective, randomized, blinded trial. Langenbeck’s Arch Surg. 2008;393:659–66.

    Article  Google Scholar 

  23. McGill J, Sturgeon C, Kaplan SP, Chiu B, Kaplan EL, Angelos P. How does the operative strategy for primary hyperparathyroidism impact the findings and cure rate? A comparison of 800 parathyroidectomies. J Am Coll Surg. 2008;207:246–9.

    Article  PubMed  Google Scholar 

  24. Westerdahl J, Bergenfelz A. Unilateral versus bilateral neck exploration for primary hyperparathyroidism. Ann Surg. 2007;246:976–81.

    Article  PubMed  Google Scholar 

  25. Yew MK, Thompson IJ. Minimally invasive parathyroidectomy: an audit of a change in clinical practice. ANZ J Surg. 2007;77:24–6.

    Article  PubMed  Google Scholar 

  26. Palmer RM, Lokey JS. Is minimally invasive parathyroidectomy reasonable in the nonuniversity setting? Am J Surg. 2006;192:865–8.

    Article  PubMed  Google Scholar 

  27. Burkey SH, Snyder WH 3rd, Nwariaku F, Watumull L, Mathews D. Directed parathyroidectomy: Feasibility and performance in 100 consecutive patients with primary hyperparathyroidism. Arch Surg. 2003;138:604–9.

    Article  PubMed  Google Scholar 

  28. Genc H, Morita E, Perrier ND, et al. Differing histologic findings after bilateral and focused parathyroidectomy. J Am Coll Surg. 2003;196:535–40.

    Article  PubMed  Google Scholar 

  29. Adler JT, Sippel RS, Chen H. The influence of surgical approach on quality of life after parathyroid surgery. Ann Surg Oncol. 2008;15:1559–65.

    Article  PubMed  Google Scholar 

  30. Russell CFJ, Dolan SJ, Laird JD. Randomized clinical trial comparing scan-directed unilateral versus bilateral cervical exploration for primary hyperparathyroidism due to solitary adenoma. Br J Surg. 2006;93:418–21.

    Article  CAS  PubMed  Google Scholar 

  31. Smit PC, Borel Rinkes IH, van Dalen A, van Vroonhoven TJ. Direct, minimally invasive adenomectomy for primary hyperparathyroidism: an alternative to conventional neck exploration? Ann Surg. 2000;231:559–65.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  32. Schneider DF, Mazeh H, Sippel RS, Chen H. Is minimally invasive parathyroidectomy associated with greater recurrence compared to bilateral exploration? Analysis of more than 1000 cases. Surgery. 2012;152:1008–15.

    Article  PubMed  PubMed Central  Google Scholar 

  33. Irvin GL 3rd, Dembrow VD, Prudhomme DL. Operative monitoring of parathyroid gland hyperfunction. Am J Surg. 1991;162:299–302.

    Article  PubMed  Google Scholar 

  34. Ospina NMS, Rodriguez-Gutierrez R, Maraka S, et al. Outcomes of parathyroidectomy in patients with primary hyperparathyroidism: a systematic review and meta-analysis. World J Surg. 2016;40:2359–77.

    Article  Google Scholar 

  35. Leiker AJ, Yen TW, Eastwood DC, et al. Factors that influence parathyroid hormone half-life: determining if new intraoperative criteria are needed. JAMA Surg. 2013;148:602–6.

    Article  PubMed  PubMed Central  Google Scholar 

  36. Lee NC, Norton JA. Multiple-gland disease in primary hyperparathyroidism: a function of operative approach? Arch Surg. 2002;137:896–900.

    Article  PubMed  Google Scholar 

  37. Tang T, Dolan S, Robinson B, Delbridge L. Does the surgical approach affect quality of life outcomes? A comparison of minimally invasive parathyroidectomy with open parathyroidectomy. Int J Surg. 2007;5:17–22.

    Article  PubMed  Google Scholar 

  38. Norman J, Politz D. Prospective study in 3000 consecutive parathyroid operations demonstrates 18 objective factors that influence the decision for unilateral versus bilateral surgical approach. J Am Coll Surg. 2010;211:244–9.

    Article  PubMed  Google Scholar 

  39. Hessman O, Westerdahl J, Al-Suliman N, Christiansen P, Hellman P, Bergenfelz A. Randomized clinical trial comparing open with video-assisted minimally invasive parathyroid surgery for primary hyperparathyroidism. Br J Surg. 2010;97:177–84.

    Article  CAS  PubMed  Google Scholar 

  40. Okoh AK, Sound S, Berber E. Robotic parathyroidectomy. J Surg Oncol. 2015;112:240–2.

    Article  PubMed  Google Scholar 

  41. Reeve TS, Babidge WJ, Parkyn RF, et al. Minimally invasive surgery for primary hyperparathyroidism: a systematic review. Aust N Z J Surg. 2000;70:244–50.

    Article  CAS  PubMed  Google Scholar 

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DISCLOSURE

The authors declare no conflict of interest.

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Authors and Affiliations

  1. Department of Academic Surgery, Cork University Hospital (CUH), Cork, Ireland

    Marcel Jinih MB BCh, Emer O’Connell MB BCh, Donal P. O’Leary MB BCh, MRCS, PhD & Henry P. Redmond MCh, FRCSI, FACS

  2. National University of Ireland Galway (NUIG), Portiuncula University Hospital and Galway University Hospital, Saolta University Health Care Group, Galway, Ireland

    Aaron Liew MB BCh, MRCPI, MRCS (Glasg), PhD

  3. Institute of Cellular Medicine, Newcastle University, Newcastle upon Tyne, UK

    Aaron Liew MB BCh, MRCPI, MRCS (Glasg), PhD

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  1. Marcel Jinih MB BCh
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  2. Emer O’Connell MB BCh
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  3. Donal P. O’Leary MB BCh, MRCS, PhD
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  4. Aaron Liew MB BCh, MRCPI, MRCS (Glasg), PhD
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  5. Henry P. Redmond MCh, FRCSI, FACS
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Correspondence to Marcel Jinih MB BCh.

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Jinih, M., O’Connell, E., O’Leary, D.P. et al. Focused Versus Bilateral Parathyroid Exploration for Primary Hyperparathyroidism: A Systematic Review and Meta-analysis. Ann Surg Oncol 24, 1924–1934 (2017). https://doi.org/10.1245/s10434-016-5694-1

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  • DOI: https://doi.org/10.1245/s10434-016-5694-1

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