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Less Than Subtotal Parathyroidectomy for Multiple Endocrine Neoplasia Type 1 Primary Hyperparathyroidism: A Systematic Review and Meta-Analysis

Abstract

Background

Multiple endocrine neoplasia type 1 (MEN1)-associated primary hyperparathyroidism (pHPT) is classically associated with an asymmetric and asynchronous parathyroid involvement. Subtotal parathyroidectomy (STP), which is currently the recommended surgical treatment, carries a high risk of permanent hypoparathyroidism. The results of less than subtotal parathyroidectomy (LSTP) are conflicting, and its place in this setting is still a matter of debate. The aim of this study was to identify the place of LSTP in the surgical management of patients with MEN-associated pHPT.

Methods

A systematic literature review was conducted in accordance with PRISMA and MOOSE guidelines, for studies comparing STP and LSTP for MEN1-associated pHPT. The results of the two techniques, regarding permanent hypoparathyroidism, persistent hyperparathyroidism and recurrent hyperparathyroidism were computed using pairwise random-effect meta-analysis.

Results

Twenty-five studies comparing STP and LSTP qualified for inclusion in the quantitative synthesis. In total, 947 patients with MEN1-associated pHPT were allocated to STP (n = 569) or LSTP (n = 378). LSTP reduces the risk of permanent hypoparathyroidism [odds ratio (OR) 0.29, confidence interval (CI) 95% 0.17–0.49)], but exposes to higher rates of persistent hyperparathyroidism [OR 4.60, 95% CI 2.66–7.97]. Rates of recurrent hyperparathyroidism were not significantly different between the two groups [OR 1.26, CI 95% 0.83–1.91].

Conclusions

LSTP should not be abandoned and should be considered as a suitable surgical option for selected patients with MEN1-associated pHPT. The increased risk of persistent hyperparathyroidism could improve with the emergence of more efficient preoperative localization imaging techniques and a more adequate patients selection.

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Acknowledgements

The authors would like to thank Madam Coralie Thore, medical librarian at the public health department of the University of Bordeaux, and Dr Antoine Benard, clinical epidemiologist in the public health department of Bordeaux University Hospital for their precious support.

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This research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors.

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Correspondence to Haythem Najah.

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The authors, Damien Bouriez, Caroline Gronnier, Magalie Haissaguerre, Antoine Tabarin, and Haythem Najah, declare that they have no conflicts of interest to disclose.

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Bouriez, D., Gronnier, C., Haissaguerre, M. et al. Less Than Subtotal Parathyroidectomy for Multiple Endocrine Neoplasia Type 1 Primary Hyperparathyroidism: A Systematic Review and Meta-Analysis. World J Surg 46, 2666–2675 (2022). https://doi.org/10.1007/s00268-022-06633-7

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