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Long-term outcome of surgical techniques for sporadic primary hyperparathyroidism in a tertiary referral center in Belgium

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Abstract

Purpose

Surgery remains the only permanent treatment option for primary hyperparathyroidism (pHPT). To date, the number of long-term outcome studies of parathyroidectomy is limited. This study aims to compare different surgical approaches and evaluate the importance of preoperative localization imaging in the treatment of pHPT.

Methods

All 200 consecutive patients with a parathyroidectomy for sporadic pHPT without planned concomitant surgery between 09/2009 and 04/2021 in a Belgian tertiary referral hospital were enrolled. All patients underwent at least two preoperative localization imaging studies (neck ultrasound, CT, SPECT, and/or Sestamibi scintigraphy) of the parathyroid glands. The main outcomes were the (long-term) cured proportion and postoperative morbidity (hypocalcemia, recurrent laryngeal nerve palsy, return to theater for bleeding, and wound morbidity).

Results

Most patients were referred with concordant positive imaging (82%, n = 164). Only nine patients (4.5%) had double negative imaging, not revealing a possible adenoma. The remaining 27 (13.5%) were referred with discordant imaging. Parathyroidectomy was performed via traditional cervicotomy (30%), mini-open approach (39.5%), or endoscopic approach (30.5%). Morbidity was low with no persistent hypocalcemia, one return to theater for bleeding, and no 30-day mortality. In the concordant imaging population, 13 patients (8%) had multiglandular disease. Overall, 97.5% was considered cured. Long-term recurrence was 12% with a minimal follow-up of 5 years.

Conclusion

This consecutive, single-surgeon, single-center cohort with extensive data collection and long-term follow-up confirms the safety and excellent cured proportions of minimally invasive parathyroidectomy. Disease recurrence becomes more important long after surgery.

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Authors and Affiliations

  1. Department of General and Endocrine Surgery, Onze-Lieve-Vrouw (OLV) Hospital Aalst, Moorselbaan 164, 9300, Aalst, Belgium

    Klaas Van Den Heede, Amélie Bonheure & Sam Van Slycke

  2. Department of Endocrine and Digestive Surgery, Hôpital Pitié-Salpêtrière, AP-HP, Sorbonne University, 47-83 Boulevard de l’Hôpital, 75013, Paris, France

    Klaas Van Den Heede

  3. Center for Translational Microbiome Research Department of Microbiology, Tumor, and Cell Biology, Karolinska Institutet, Karolinska Hospital, Tomtebodavagen 16, 17165, Stockholm, Sweden

    Nele Brusselaers

  4. Department of Head and Skin, University Hospital Ghent, Corneel Heymanslaan 10, 9000, Ghent, Belgium

    Sam Van Slycke

  5. Global Health Institute, University of Antwerp, Doornstraat 331, 2610, Antwerp, Wilrijk, Belgium

    Nele Brusselaers

  6. Department of General Surgery, AZ Damiaan, Gouwelozestraat 100, 8400, Ostend, Belgium

    Sam Van Slycke

Authors
  1. Klaas Van Den Heede
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  2. Amélie Bonheure
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  4. Sam Van Slycke
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Contributions

Klaas Van Den Heede (0000–0003-3642–9514): study conception and design, acquisition of data, analysis and interpretation of data, and drafting of the manuscript. Amélie Bonheure: study conception and design, acquisition of data, analysis and interpretation of data, and drafting of the manuscript. Nele Brusselaers (0000–0003-0137-447X): study conception and design, analysis and interpretation of data, and critical revision of the manuscript. Sam Van Slycke (0000–0002-8292–9475): study conception and design, analysis and interpretation of data, and critical revision of the manuscript.

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Correspondence to Klaas Van Den Heede.

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Klaas Van Den Heede and Amélie Bonheure equally contributed to this manuscript as first authors.

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Van Den Heede, K., Bonheure, A., Brusselaers, N. et al. Long-term outcome of surgical techniques for sporadic primary hyperparathyroidism in a tertiary referral center in Belgium. Langenbecks Arch Surg 407, 3045–3055 (2022). https://doi.org/10.1007/s00423-022-02660-z

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  • DOI: https://doi.org/10.1007/s00423-022-02660-z

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