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Long-Term Outcome in Patients with Primary Hyperparathyroidism who Underwent Minimally Invasive Parathyroidectomy

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Abstract

Background

Minimally invasive parathyroidectomy (MIP) has become a well-accepted treatment for selected patients with primary hyperparathyroidism (PHPT). However, few studies have evaluated long-term outcomes for this operative approach. We therefore chose to examine both the long-term symptom resolution and biochemical cure following MIP for PHPT.

Methods

A total of 460 PHPT patients who underwent a MIP between 2004 and 2009 were successfully mailed a questionnaire that assessed preoperative and postoperative Parathyroidectomy Assessment of Symptoms (PAS) scores, most recent calcium and parathyroid hormone (PTH) levels, and information about any reoperation for PHPT. Long-term evaluation of symptomatic and biochemical cure was performed.

Results

A total of 200 patients (43.5%) responded to our correspondence. The mean age of the patients was 58.7 ± 11.9 years, 74.5% were female, and 78.5% were Caucasian. The mean follow-up was 37 ± 19 months. The mean PAS scores fell by 117 ± 14 at long-term follow-up after MIP (P < 0.0001). All 13 symptoms comprising the PAS score diminished, of which ten did so significantly (P < 0.01). There was a significant drop in the mean serum calcium (preop. 11.1 mg/dl, postop. 9.6 mg/dl; P < 0.0001) and PTH (preop. 130.9 pg/ml, postop. 45.7 pg/ml; P < 0.0001) at long-term follow-up. Five patients (2.5%) developed recurrent disease (calcium > 10.5 mg/dl), and one (0.5%) underwent a reoperation for persistent disease and was subsequently cured.

Conclusions

This study demonstrates that MIP has long-term benefits in terms of excellent symptom resolution and a high biochemical cure rate (97%) in selected patients who have PHPT, preoperative localization with sestamibi scans, and assessment of intraoperative PTH level.

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Conflict of interest

The authors have no conflicts of interest, commercial associations, or intent of financial gain regarding the presented study.

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Authors and Affiliations

  1. Endocrine Surgery Section, Department of Surgery, Johns Hopkins University School of Medicine, 600 North Wolfe Street, Blalock 606, Baltimore, MD, 21287, USA

    Raghunandan Venkat, Guennadi Kouniavsky, Eric B. Schneider, Alan P. B. Dackiw & Martha A. Zeiger

  2. Department of Otolaryngology and Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA

    Ralph P. Tufano

  3. Department of Oncology, Johns Hopkins University School of Medicine, Baltimore, MD, USA

    Martha A. Zeiger

  4. Department of Cellular and Molecular Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA

    Martha A. Zeiger

Authors
  1. Raghunandan Venkat
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  2. Guennadi Kouniavsky
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  3. Ralph P. Tufano
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  4. Eric B. Schneider
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  5. Alan P. B. Dackiw
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  6. Martha A. Zeiger
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Correspondence to Martha A. Zeiger.

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Venkat, R., Kouniavsky, G., Tufano, R.P. et al. Long-Term Outcome in Patients with Primary Hyperparathyroidism who Underwent Minimally Invasive Parathyroidectomy. World J Surg 36, 55–60 (2012). https://doi.org/10.1007/s00268-011-1344-8

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  • DOI: https://doi.org/10.1007/s00268-011-1344-8

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