World Journal of Surgery

, Volume 34, Issue 9, pp 2223–2227 | Cite as

Long-Term Symptom Relief from Primary Hyperparathyroidism Following Minimally Invasive Parathyroidectomy

Article

Abstract

Background

The affect of the surgical approach for primary hyperparathyroidism (1HPT) on long-term symptom relief has not been studied. This study compares the long-term relief of symptoms assessed by the Parathyroidectomy Assessment of Symptoms (PAS) score in patients undergoing bilateral neck exploration (BNE) and minimally invasive parathyroidectomy (MIP).

Methods

In this case–control study, patients with 1HPT who had followed a protocol to assess symptoms before and after parathyroid surgery between 1999 and 2008 were contacted by letter and had blood taken to assess calcium, ionized calcium, and parathyroid hormone (PTH). The main aim was to assess symptoms at long-term follow-up using the PAS score. The incidence of persistent or recurrent 1HPT at long-term follow-up after MIP and BNE was also compared.

Results

Two hundred and forty-six patients underwent parathyroid surgery and 142 responded to our correspondence, of which 64 underwent MIP and 78 BNE. Follow-up after BNE was longer than MIP (61 vs. 41 months). At long-term follow-up, the mean PAS score fell by 125 and 175 in the MIP and BNE groups, respectively. There was no statistically significant difference in the decline of the PAS score between the MIP and BNE groups. Six patients developed persistent or recurrent 1HPT following MIP compared to three after BNE; this difference was not statistically significant.

Conclusions

This study is the first to report on long-term symptom relief from 1HPT after MIP, and demonstrates that both MIP and BNE can achieve this. In order to establish whether the long-term outcomes from these procedures are equivalent, further adequately powered studies are required.

References

  1. 1.
    Sackett WR, Barraclough B, Reeve TS et al (2002) Worldwide trends in the surgical management of primary hyperparathyroidism in the era of minimally invasive parathyroidectomy. Arch Surg 137:1055–1059CrossRefPubMedGoogle Scholar
  2. 2.
    Caron N, Pasieka JL (2009) What symptom improvement can be expected after operation for primary hyperparathyroidism? World J Surg 33:2244–2255CrossRefPubMedGoogle Scholar
  3. 3.
    Caillard C, Sebag F, Mathonnet M et al (2007) Prospective evaluation of quality of life (SF-36v2) and nonspecific symptoms before and after cure of primary hyperparathyroidism (1-year follow-up). Surgery 141(2):153–160CrossRefPubMedGoogle Scholar
  4. 4.
    Mihai R, Sadler G (2008) Pasieka’s parathyroid symptoms scores correlate with SF-36 scores in patients undergoing surgery for primary hyperparathyroidism. World J Surg 32:807–814CrossRefPubMedGoogle Scholar
  5. 5.
    Tang T, Dolan S, Robinson B et al (2007) Does the surgical approach affect quality of life outcomes?—a comparison of minimally invasive parathyroidectomy with open parathyroidectomy. Int J Surg 5:17–22CrossRefPubMedGoogle Scholar
  6. 6.
    Agarwal G, Barraclough B, Reeve T et al (2002) Minimally invasive parathyroidectomy using the “focused” lateral approach. II. Surgical technique. ANZ J Surg 72(2):147–151CrossRefPubMedGoogle Scholar
  7. 7.
    Irvin GL, Sfakianakis G, Yeung L et al (1996) Ambulatory parathyroidectomy for primary hyperparathyroidism. Arch Surg 131(10):1074–1078PubMedGoogle Scholar
  8. 8.
    Udelsman R, Donovan PI, Sokoll LJ (2000) One hundred consecutive minimally invasive parathyroid operations. Ann Surg 232(3):331–339CrossRefPubMedGoogle Scholar
  9. 9.
    Westerdal J, Lindblom P, Valdemarsson S et al (2000) Risk factors for postoperative hypocalcaemia after surgery for primary hyperparathyroidism. Arch Surg 135:142–147CrossRefGoogle Scholar
  10. 10.
    Prasannan S, Davies G, Bochner M et al (2007) Minimally invasive parathyroidectomy using surgeon-based ultrasound and sestamibi. ANZ J Surg 77:774–777CrossRefPubMedGoogle Scholar
  11. 11.
    Ware JE, Sherbourne CD (1992) The MOS 35-item short-form health survey (SF-36): I. Conceptual framework and item selection. Med Care 30:473–483CrossRefPubMedGoogle Scholar
  12. 12.
    Pasieka JL, Parsons LL (1998) Prospective surgical outcome study of relief of symptoms following surgery in patients with primary hyperparathyroidism. World J Surg 22:513–519CrossRefPubMedGoogle Scholar
  13. 13.
    Pasieka JL, Parsons LL, Demeure MJ et al (2002) Patient-based surgical outcome tool demonstrating alleviation of symptoms following parathyroidectomy in patients with primary hyperparathyroidism. World J Surg 26:942–949CrossRefPubMedGoogle Scholar
  14. 14.
    Pasieka JL, Parsons L, Jones J (2009) The long-term benefit of parathyroidectomy in primary hyperparathyroidism: a 10-year prospective surgical outcome study. Surgery 146(6):1006–1013CrossRefPubMedGoogle Scholar
  15. 15.
    Westerdahl J, Bergenfelz A (2007) Unilateral versus bilateral exploration for primary hyperparathyroidism: five-year follow-up of a randomized controlled trial. Ann Surg 246(6):976–981CrossRefPubMedGoogle Scholar
  16. 16.
    Sidhu S, Neill AK, Russell MB (2003) Long-term outcome of unilateral parathyroid exploration for primary hyperparathyroidism due to presumed solitary adenoma. World J Surg 27:339–342CrossRefPubMedGoogle Scholar
  17. 17.
    Carneiro DM, Irvin GL (2000) Late parathyroid function after successful parathyroidectomy guided by intraoperative hormone assay (QPTH) compared with standard bilateral neck exploration. Surgery 128(6):925–929CrossRefPubMedGoogle Scholar
  18. 18.
    Allendorf J, DiGorgi M, Spanknebel K et al (2007) 1112 consecutive bilateral neck explorations for primary hyperparathyroidism. World J Surg 31:2075–2080CrossRefPubMedGoogle Scholar

Copyright information

© Société Internationale de Chirurgie 2010

Authors and Affiliations

  • Sebastian R. Aspinall
    • 1
  • Sam Boase
    • 2
  • Peter Malycha
    • 3
  1. 1.Northumbria Healthcare NHS Foundation Trust, North Tyneside General HospitalNorth ShieldsUK
  2. 2.Department of Ear, Nose and Throat SurgeryRoyal Adelaide HospitalAdelaideAustralia
  3. 3.Breast, Endocrine and Surgical Oncology UnitRoyal Adelaide HospitalAdelaideAustralia

Personalised recommendations