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Subtotal parathyroidectomy versus total parathyroidectomy and autotransplantation in secondary hyperparathyroidism: A randomized trial

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Abstract

In a randomized study subtotal parathyroidectomy (sPTX) was compared with total parathyroidectomy and autotransplantation of fresh tissue (PTX+AT) in 40 patients with severe secondary hyperparathyroidism (HPT). After surgery both groups were followed at 19±6 months (PTX +AT) and 19±7 months (sPTX) and at 43±9 months (PTX+AT) and 40±7 months (sPTX). There were 17 patients alive in each group at the time of the second follow-up. After sPTX, 2 patients required re-operation because of recurrent disease originating from the remaining parathyroid gland in the neck and another 2 patients were hypercalcemic at follow-up. After PTX + AT both serum calcium and alkaline phosphatase normalized significantly more often (p <0.03) than after sPTX. Re-operations were not required in this group. Radiological signs also improved significantly more after PTX+AT, as did clinical signs like pruritus (p < 0.005) and muscle weakness (p <0.04). These results and the fact that in recurrent disease a re-operation at the autograft in the forearm is simpler than a re-operation in the neck, lead to the recommendation that PTX+ AT should be considered as the method of choice in the surgical treatment of secondary HPT.

Résumé

Dans une étude randomisée, la parathyroÏdectomie subtotale (sPTX) a été comparée à la parathyroÏdectomie totale avec autotransplantation (PTX + AT) chez 40 patients ayant une hyperparathyroÏdie secondaire sévère (HPT). Après l'operation, les deux groupes de patients one été revus deux fois: à 19 ± 6 et à 43 ± 9 mois pour le groupe PTX + AT, et à 19 ± 7 et à 40 ± 7 mois pour le groupe sPTX. Dix-sept patients étaient en vie dans chaque groupe à la deuxième visite de contrÔle. Après sPTX, deux patients ont du Être réopérés en raison de tissu parathyroÏden résiduel; deux autres patients sont restés hypercalémiques. Après PTX + AT, la calcémie et le taux de phosphatases alcalines se sont normalisés plus souvent(P < 0.03) qu'après sPTX. Aucune réopération n'a été nécessaire dans le group PTX + AT. De mÊme, les signes radiologiques, les signes cliniques tels le prurit (p<0.005) et la faiblesse musculaire (p< 0.04) se sont améliorés plus souvent de faÇon significative dans le groupe PTX + AT. Ces résultats et le fait que lors des récidives, une autogreffe à l'avant-bras est plus simple qu'une réexploration cervicale, nous amène à préconiser la PTX + AT comme méthode de choix dans le traitement chirurgical de l'HPT.

Resumen

En un estudio randomizado se compararon la paratiriodectomía subtotal (sPTX) con la paratiroidectomía total con autotrasplante de tejido fresco (PTX + AT) en 40 pacientes con hiperparatiroidismo secundario severo (HPT). Ambos grupos fueron valorados dos veces después de la cirugía; a los 19±6 meses (PTX + AT) y 19±7 meses (sPTX) y a los 43±9 meses (PTX + AT) y los 40±7 meses (s(PTX). Se encontraron 17 pacientes vivos en cada grupo en el momenta de la segunda valoración. Después de sPTX 2 pacientes requirieron reoperación por enfermedad recurrente originada en la glándula paratiroides remanente en el cuello y otros 2 aparecieron hipercalcémicos. Después de PTX + AT tanto el calcio sérico como la fosfatasa alcalina se normalizaron significativamente con mayor frecuencia (p<0.03) que después de sPTX; no se requirieron reoperaciones en este grupo. Los signos radiológicos también mejoraron significativamente con mayor frecuencia después de PTX + AT, tal como lo hicieron signos clínicos tales como prurito (p<0.005) y debilidad muscular (p<0.04). Estas resultados, junto con el hecho de que en la enfermedad recurrente una reoperación sobre el autoinjerto en el antebrazo es más simple que una operación en el cuello, da lugar a recommendar que la PTX + AT es el método de escogencia en el manejo quirÚrgico del sHPT.

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  1. Department of Surgery, Philipps University, Marburg, Federal Republic of Germany

    Matthias Rothmund M.D., Peter K. Wagner M.D. & Claudia Schark M.D.

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  1. Matthias Rothmund M.D.
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  2. Peter K. Wagner M.D.
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  3. Claudia Schark M.D.
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Rothmund, M., Wagner, P.K. & Schark, C. Subtotal parathyroidectomy versus total parathyroidectomy and autotransplantation in secondary hyperparathyroidism: A randomized trial. World J. Surg. 15, 745–750 (1991). https://doi.org/10.1007/BF01665309

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