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World Journal of Surgery

, Volume 28, Issue 12, pp 1287–1292 | Cite as

Quick Intraoperative Parathyroid Hormone Assay: Surgical Adjunct to Allow Limited Parathyroidectomy, Improve Success Rate, and Predict Outcome

  • George L. IrvinEmail author
  • Carmen C. Solorzano
  • Denise M. Carneiro
Article

Abstract

Intraoperative parathyroid hormone (PTH) assay (QPTH) has made possible less invasive operative approaches in the treatment of primary hyperparathyroidism with stated advantages. When compared to the traditional bilateral neck exploration (BNE), only the targeted, hypersecreting gland is excised, leaving in situ non-visualized but normally functioning parathyroids. The QPTH-guided limited parathyroidectomy (LPX) must be able to identify multiglandular disease (MGD), predict a successful outcome, and have a low recurrence rate. In our series, 421 patients who underwent LPX were compared to 340 undergoing BNE; all operative failures and patients followed for 6 months or longer were included. Operative failure occurred if serum calcium and PTH levels were elevated within 6 months of parathyroidectomy. Multiglandular disease was defined in the LPX group as more than one gland excision guided by QPTH or operative failure after removal of a single abnormal gland; in the BNE group it was defined as excision of more than one enlarged gland. Recurrence was defined as elevated calcium and PTH after 6 months of eucalcemia. Operative failure and MGD rates were compared using chi-squared analysis. The method of Kaplan-Meier and the log-rank test were used to compare recurrence rates. Operative success was seen in 97% of LPX patients and in 94% of the BNE group (p = 0.02). Multiglandular disease was identified in 3% of LPX patients and 10% of BNE patients (p < 0.001). There was no statistical difference in the overall recurrence rates (p = 0.23). The QPTH-guided parathyroidectomy identifies MGD and allows an improved success rate with the same low recurrence rate when compared to the results of BNE.

Keywords

Parathyroid Gland Operative Failure Bilateral Neck Exploration Multiglandular Disease Abnormal Gland 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

Notes

Acknowledgments

We acknowledge the assistance of Marcela Ramirez, M.D., and Theresa Lee, M.D., and thank them for the data collection and patient follow-up required for the preparation of this manuscript.

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Copyright information

© Société Internationale de Chirurgie 2004

Authors and Affiliations

  • George L. Irvin
    • 1
    • 2
    • 3
    Email author
  • Carmen C. Solorzano
    • 1
    • 2
  • Denise M. Carneiro
    • 1
  1. 1.DeWitt Daughtry Family Department of SurgeryUniversity of Miami/Jackson Memorial HospitalMiamiUSA
  2. 2.Sylvester Comprehensive Cancer CenterMiamiUSA
  3. 3.Veterans Affairs Medical CenterMiamiUSA

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