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Operative Failure in Minimally Invasive Parathyroidectomy Utilizing an Intraoperative Parathyroid Hormone Assay

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

Abstract

Background

Minimally invasive parathyroidectomy (MIP) is a targeted operation to cure primary hyperparathyroidism utilizing intraoperative parathyroid hormone monitoring (IOPTH). The purpose of this study was to quantify the operative failure of MIP.

Methods

Utilizing institutional parathyroid surgery database, demographic, operative, and biochemical data were analyzed for successful and failed MIP. Operative failure was defined as <6 months of eucalcemia after operation.

Results

Five hundred thirty-eight patients (96.6 %) had successful MIP with mean follow-up of 13 months, and 19 (3.4 %) had operative failure. The major cause of operative failure (11 of 19) was the result of surgeons’ inability to identify all abnormal parathyroid glands. The remaining eight operative failures were the result of falsely positive IOPTH results. Eleven of 19 patients whose MIP had failed underwent a second parathyroid surgery. All but one of these patients achieved operative success, and 9 patients had missed multigland disease. Only 46 (8.3 %) of 557 patients had conversion to bilateral cervical exploration (BCE). Eighty percent of patients had more than 70 % IOPTH decrease, and all had successful operations. Patients with a marginal IOPTH decrease (50–59 %) had a treatment failure rate of 20 %.

Conclusions

The most common cause of operative failure in MIP utilizing IOPTH was the result of surgeons’ failure to identify all abnormal parathyroid glands. Falsely positive IOPTH is rare, and a targeted MIP utilizing IOPTH can achieve an excellent operative success rate without routine BCE. Selective BCE on patients with marginal IOPTH decrease may improve surgical outcome.

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Acknowledgment

Supported in part by The MD Anderson Cancer Center Support Grant CA016672. We thank Zach Bohannan and Melissa Burkett from The University of Texas MD Anderson Cancer Center Department of Scientific Publications for their assistance.

Disclosure

The authors declare no conflict of interest.

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Authors and Affiliations

  1. Section of Surgical Endocrinology, Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA

    Sukhyung Lee MD, Haengrang Ryu MD, Lilah F. Morris MD, Elizabeth G. Grubbs MD, Jeffrey E. Lee MD & Nancy D. Perrier MD

  2. Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA

    Nusrat Harun MS & Lei Feng MS

  3. Department of Surgery, John P. Murtha Cancer Center, Walter Reed National Military Medical Center, Bethesda, MD, USA

    Sukhyung Lee MD

  4. Department of Surgery, Hongik Hospital, Seoul, Republic of Korea

    Haengrang Ryu MD

Authors
  1. Sukhyung Lee MD
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  2. Haengrang Ryu MD
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  3. Lilah F. Morris MD
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  4. Elizabeth G. Grubbs MD
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  5. Jeffrey E. Lee MD
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  6. Nusrat Harun MS
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  7. Lei Feng MS
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  8. Nancy D. Perrier MD
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Correspondence to Sukhyung Lee MD.

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Lee, S., Ryu, H., Morris, L.F. et al. Operative Failure in Minimally Invasive Parathyroidectomy Utilizing an Intraoperative Parathyroid Hormone Assay. Ann Surg Oncol 21, 1878–1883 (2014). https://doi.org/10.1245/s10434-013-3479-3

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  • DOI: https://doi.org/10.1245/s10434-013-3479-3

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