Abstract
Purpose
Knowledge about compliance with recommendations derived from the positional statement of the European Society of Endocrine Surgeons on modern techniques in primary hyperparathyroidism surgery and the Third International Workshop on management of asymptomatic primary hyperparathyroidism is scarce. Our purpose was to check it on a bi-national basis and determine whether management differences may have impact on surgical outcomes.
Methods
An online survey including questions about indications, preoperative workup, surgical approach, intraoperative adjuncts, and outcomes was sent to institutions affiliated to the endocrine surgery divisions of the National Surgical Societies from Spain and Portugal. A descriptive evaluation of the responses was performed. Finally, we assessed the correlation between the different types of management with the achievement of optimal results, defined as a cure rate equal or greater than the median of all interviewed institutions.
Results
Fifty-seven hospitals (41 Spanish, 16 Portuguese) answered the survey. First-ordered imaging tests were neck ultrasound and sestamibi scan. Facing negative or non-concordant results, 44 % of surgeons ordered additional tests before first-time surgery, and 84 % before reoperations. When indicated, selective parathyroidectomy was an acceptable option for 95 % of institutions as first-time surgery and for 51 % in reoperations. Intraoperative parathormone measurements were used by 92 % of departments. The surgical outcomes were good in most institutions (median cure rate 97 %) and were influenced mostly by the presence of an endocrine surgery unit in the surgical department (p = 0.038).
Conclusions
Practice of Iberian endocrine surgeons is consistent with current recommendations on surgery for primary hyperparathyroidism, with variability in some areas.
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Acknowledgments
The Endocrine Surgery Divisions of the National Surgical Societies from Spain and Portugal wish to thank to all the Iberpara participating investigators:
Miguel Allen, Cristina Álvarez Segurado, Alexandre Alves, Teresa Alves Conceiçao, Borja Barrios Treviño, Adolfo Basáñez Amuchástegui, Elisabeth Bollo Arocena, José Miguel Bravo de Lifante, Marifé Candel Arenas, João Capela Costa, Ana Carrión Tomás, Daniel Casanova Rituerto, Olimpia Cid, Pablo Colsa Gutiérrez, José Mario Coutinho, Carlos Cruz, Aitor de la Quintana Basarrate, Leonardo De Tursi Rispoli, Joan Doménech Calvet, Manuel Durán Poveda, Rosário Eusébio, Benito Flores Pastor, Francisco García Lorenzo, Joaquín Gómez Ramírez, Carmen González Sánchez, Xavier Guirao Garriga, Antonio Jiménez García, Javier Jiménez Olmo, Pedro Koch, Itziar Larrañaga Blanc, Jesús Martín Fernández, Rosario Martínez García, José Ignacio Martínez Pueyo, Cristina Martínez Santos, Juan Manuel Martos Martínez, Armando Medeiros, Enrique Mercader Cidoncha, Antonio Moral Duarte A, Pablo Moreno Llorente, José Manuel Nuño Vázquez-Garza, Ana Oliveira, Joaquín Ortega Serrano, José Polónia, Antónia Póvoa, José Antonio Puñal Rodríguez, Ana Rafael, José Rocha, Susana Ros López, Jorge Rosa Santos, Pilar Salvador Egea, Antonio Sitges-Serra, Teixeira Gomes, Pedro Trillo Parejo, Óscar Vidal Pérez, Jesús Villar del Moral, Pedro José Yunta Abarca.
The authors also appreciate the translation assistance from Rosa María Vidal Quintana.
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Appendix 1: Text of the survey
Appendix 1: Text of the survey
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Villar-del-Moral, J., Capela-Costa, J., Jiménez-García, A. et al. Compliance with recommendations on surgery for primary hyperparathyroidism—from guidelines to real practice: results from an Iberian survey. Langenbecks Arch Surg 401, 953–963 (2016). https://doi.org/10.1007/s00423-015-1362-3
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DOI: https://doi.org/10.1007/s00423-015-1362-3