Outcomes of Parathyroidectomy in Patients with Primary Hyperparathyroidism: A Systematic Review and Meta-analysis
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Parathyroidectomy is a definitive treatment for primary hyperparathyroidism. Patients contemplating this intervention will benefit from knowledge regarding the expected outcomes and potential risks of the currently available surgical options.
To appraise and summarize the available evidence regarding benefits and harms of minimally invasive parathyroidectomy (MIP) and bilateral neck exploration (BNE).
A comprehensive search of multiple databases (MEDLINE, EMBASE, and Scopus) from each database’s inception to September 2014 was performed.
Eligible studies evaluated patients with primary hyperparathyroidism undergoing MIP or BNE.
Reviewers working independently and in duplicate extracted data and assessed the risk of bias.
We identified 82 observational studies and 6 randomized trials at moderate risk of bias. Most of them reported outcomes after MIP (n = 71). Using random-effects models to pool results across studies, the cure rate was 98 % (95 % CI 97–98 %, I 2 = 10 %) with BNE and 97 % (95 % CI 96–98 %, I 2 = 86 %) with MIP. Hypocalcemia occurred in 14 % (95 % CI 10–17 % I 2 = 93 %) of the BNE cases and in 2.3 % (95 % CI 1.6–3.1 %, I 2 = 87 %) with MIP (P < 0.001). There was a statistically significant lower risk of laryngeal nerve injury with MIP (0.3 %) than with BNE (0.9 %), but similar risk of infection (0.5 vs. 0.5 %) and mortality (0.1 vs. 0.5 %).
The available evidence, mostly observational, is at moderate risk of bias, and limited by indirect comparisons and inconsistency for some outcomes (cure rate, hypocalcemia).
MIP and BNE are both effective surgical techniques for the treatment of primary hyperparathyroidism. The safety profile of MIP appears superior to BNE (lower rate of hypocalcemia and recurrent laryngeal nerve injury).
KeywordsHypercalcemia Primary Hyperparathyroidism Serum Calcium Level Indirect Comparison Previous Systematic Review
This publication was made possible by CTSA Grant Number UL1 TR000135 from the National Center for Advancing Translational Sciences (NCATS), a component of the National Institutes of Health (NIH). Its contents are solely the responsibility of the authors and do not necessarily represent the official view of NIH.
NSO, RRG, SM, and VMM served as overall principal investigators, designed the study, wrote the protocol, extracted the data, made statistical analysis, interpreted the data, and wrote and reviewed the manuscript. SJ, AEEY, and ACG helped with the extraction, statistical analysis, made a critical review of manuscript, and assisted with protocol adaptations and submissions. MRG, AAN, and JPB helped with the extraction, analyzed the data, made a critical review of the manuscript, and assisted with protocol adaptations and submissions. PE helped with the search strategy, made a critical review of the manuscript, and assisted with protocol adaptations and submissions. MR and RW interpreted the data, made a critical review of the manuscript, and assisted with protocol adaptations and submissions. NSO and VMM are guarantors. All authors read and approved the final manuscript.
MRG was supported by CTSA Grant Number TL1 TR000137 from the National Center for Advancing Translational Science (NCATS). The contents of this manuscript are solely the responsibility of the authors and do not necessarily represent the official views of the NIH. This publication was made possible by CTSA Grant Number UL1 TR000135 from the National Center for Advancing Translational Sciences (NCATS), a component of the National Institutes of Health (NIH). Its contents are solely the responsibility of the authors and do not necessarily represent the official view of NIH.
Compliance with ethical standards
Conflict of interests
The authors declare no conflict of interest.
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