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Subtotal Parathyroidectomy Versus Total Parathyroidectomy with Autotransplantation for Patients with Multiple Endocrine Neoplasia 1 and Primary Hyperparathyroidism

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Difficult Decisions in Endocrine Surgery

Part of the book series: Difficult Decisions in Surgery: An Evidence-Based Approach ((DDSURGERY))

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Abstract

Hyperparathyroidism in patients with MEN 1 is characterized by multiple gland involvement. Two surgical approaches have been advocated in these patients: total parathyroidectomy with heterotopic autotransplantation of parathyroid tissue grafts into skeletal muscle (TP/AT), or subtotal (3 and ½ gland) parathyroidectomy (SP) leaving a vascularized remnant of parathyroid tissue in situ in the neck. Despite the potential advantages and disadvantages of these two commonly practiced operations, previous retrospective studies have demonstrated similar overall rates of recurrent HPT and permanent postoperative hypoparathyroidism in patients undergoing the two operative procedures. Although one of these approaches is often preferred by individual endocrine surgery centers of excellence, improved outcomes or a clear advantage for either operation has not been previously established. The cumulative evidence from prior retrospective studies and a single randomized controlled trail is presented, and recommendations are made based on the available data. The level of evidence and grade for the strength of these recommendations is provided.

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Author information

Authors and Affiliations

  1. Division of Surgical Oncology, Department of Surgery, Baylor Scott and White Health, Texas A&M University Health Science Center, Temple, TX, USA

    Terry C. Lairmore

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  1. Terry C. Lairmore
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Correspondence to Terry C. Lairmore .

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Editors and Affiliations

  1. Department of Surgery and MacLean Center for Clinical Medical Ethics, The University of Chicago, Chicago, IL, USA

    Peter Angelos

  2. Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX, USA

    Raymon H. Grogan

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Lairmore, T.C. (2018). Subtotal Parathyroidectomy Versus Total Parathyroidectomy with Autotransplantation for Patients with Multiple Endocrine Neoplasia 1 and Primary Hyperparathyroidism. In: Angelos, P., Grogan, R. (eds) Difficult Decisions in Endocrine Surgery. Difficult Decisions in Surgery: An Evidence-Based Approach. Springer, Cham. https://doi.org/10.1007/978-3-319-92860-9_15

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  • DOI: https://doi.org/10.1007/978-3-319-92860-9_15

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  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-92858-6

  • Online ISBN: 978-3-319-92860-9

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