Abstract
Purpose
Parathyroidectomy for ectopic mediastinal hyperfunctioning glands could be performed by transcervical approach, sternotomy, thoracotomy, and recently by thoracoscopic and mediastinoscopic approaches. This study was aimed to analyze the results of traditional and video-assisted parathyroidectomy for mediastinal benign hyperfunctioning glands.
Methods
Fifty-one upper mediastinal exploration by a conventional cervicotomy, 12 by video-assisted approaches (two thoracoscopy and 10 transcervical mediastinoscopy) and six by sternotomy were performed in 63 patients with primary hyperparathyroidism.
Results
Video-assisted and sternotomic parathyroid explorations achieved biochemical cure in all cases; following conventional transcervical mediastinal exploration, a persistent hyperparathyroidism occurred in 11.8% of patients, who were subsequently cured by sternotomic approach. No complications occurred after video-assisted parathyroidectomy, while an overall morbidity rate of 50% and 10% was found after sternotomic and conventional cervicotomic approaches. Postoperative pain and hospital stay were significantly increased following sternotomy; patient's subjective cosmetic satisfaction was significantly higher after video-assisted and conventional cervicotomic approaches.
Conclusions
Conventional cervicotomic parathyroidectomy may achieve satisfactory results, especially for upper mediastinal glands. Sternotomic approaches are effective, but should be limited because of invasiveness and increased morbidity. In case of deep and lower hyperfunctioning mediastinal parathyroids, video-assisted approaches represent a less invasive, effective, and safe alternative and might be the technique of choice.
Similar content being viewed by others
References
Van Heerden JA, Grant CS (1991) Surgical treatment of primary hyperparathyroidism: an institutional perspective. World J Surg 15:688–692
Kaplan EL, Yashiro T, Salti G (1992) Primary hyperparathyroidism in the 1990s. Ann Surg 215:300–317
Alesina PF, Moka D, Mahlstedt J, Walz MK (2008) Thoracoscopic removal of mediastinal hyperfunctioning parathyroid glands: personal experience and review of the literature. World J Surg 32:224–231
Nathaniels EK, Nathaniels AM, Wang C (1970) Mediastinal parathyroid tumors: a clinical and pathological study of 84 cases. Ann Surg 171:165–170
Nwariaku FE, Snyder WH, Burkey SH, Watumull L, Mathews D (2005) Inframanubrial parathyroid glands in patients with primary hyperparathyroidism: alternatives to sternotomy. World J Surg 29:491–494
Cupisti K, Dotzenrath C, Simon D, Röher HD, Goretzki PE (2002) Therapy of suspected intrathoracic parathyroid adenomas. Experiences using open transthoracic approach and video-assisted thoracoscopic surgery. Langenbecks Arch Surg 386:488–493
Callender GG, Grubbs EG, Vu T, Hofstetter WL, Fleming JB, Woodburn KL, Lee JE, Evans DB, Perrier ND (2009) The fallen one: the inferior parathyroid gland that descends into the mediastinum. J Am Coll Surg 208:887–893
Randone B, Costi R, Scatton O, Fulla Y, Bertagna X, Soubrane O, Bonnichon P (2009) Thoracoscopic removal of mediastinal parathyroid glands: a critical appraisal of an emerging technique. Ann Surg 251:717–721
Henry JF, Defechereux T, Raffaelli M, Lubrano D, Iacobone M (2000) Supernumerary ectopic hyperfunctioning parathyroid gland: a potential pitfall in surgery for sporadic primary hyperthyroidism. Ann Chir 125:247–252
Mihai R, Barczynski M, Iacobone M, Sitges-Serra A (2009) Surgical strategy for sporadic primary hyperparathyroidism an evidence-based approach to surgical strategy, patient selection, surgical access, and reoperations. Langenbecks Arch Surg 394:785–798
Iacobone M, Ruffolo C, Lumachi F, Favia G (2005) Results of iterative surgery for persistent and recurrent parathyroid carcinoma. Langenbecks Arch Surg 390:385–390
Clark OH (1988) Mediastinal parathyroid tumors. Arch Surg 123:1096–1100
Nilubol N, Beyer T, Prinz RA, Solorzano CC (2007) Mediastinal hyperfunctioning parathyroids: incidence, evolving treatment, and outcome. Am J Surg 194:53–56
Russell CF, Edis AJ, Scholz DA, Sheedy PF, van Heerden JA (1981) Mediastinal parathyroid tumors: experience with 38 tumors requiring mediastinostomy for removal. Ann Surg 193:805–809
Prinz RA, Lonchyna V, Carnaille B, Wurtz A, Proye C (1994) Thoracoscopic excision of enlarged mediastinal parathyroid glands. Surgery 116:999–1004
Henry JF, Iacobone M, Mirallie E, Deveze A, Pili S (2001) Indications and results of video-assisted parathyroidectomy by a lateral approach in patients with primary hyperparathyroidism. Surgery 130:999–1004
Henry JF, Raffaelli M, Iacobone M, Volot F (2001) Video-assisted parathyroidectomy via the lateral approach vs conventional surgery in the treatment of sporadic primary hyperparathyroidism: results of a case-control study. Surg Endosc 15:1116–1119
Sukumar MS, Komanapalli CB, Cohen JI (2006) Minimally invasive management of the mediastinal parathyroid adenoma. Laryngoscope 116:482–487
Conn JM, Goncalves MA, Mansour KA, McGarity WC (1991) The mediastinal parathyroid. Am Surg 57:62–66
Ikeda Y, Tajima G, Miyabe R, Takayama J, Takami H, Okinaga K (2005) Cervical excision using superior sternum lifting method for large mediastinal parathyroid gland. J Surg Oncol 89:265–267
Moreno P, Francos JM, Shaha A, Bosch A, de Lama E, Rafecas A, Jaurrieta E (2007) Intercostal video-assisted mediastinal surgery through an intercostal window (IVAMS): a simpler approach to perform mediastinal parathyroidectomy. Surgery 142:410–413
Amar L, Guignat L, Tissier F, Richard B, Vignaux O, Fulla Y, Legmann P, Bertagna X, Bonnichon P (2004) Video-assisted thoracoscopic surgery as a first-line treatment for mediastinal parathyroid adenomas: strategic value of imaging. Eur J Endocrinol 150:141–147
Kumar A, Kumar S, Aggarwal S, Kumar R, Tandon N (2002) Thoracoscopy: the preferred method for excision of mediastinal parathyroids. Surg Laparosc Endosc Percutan Tech 12:295–300
Iacobone M, Masi G, Barzon L, Porzionato A, Macchi V, Ciarleglio FA, Palù G, De Caro R, Viel G, Favia G (2009) Hyperparathyroidism-jaw tumor syndrome: a report of three large kindred. Langenbecks Arch Surg 394:817–825
Iacobone M, Lumachi F, Favia G (2004) Up-to-date on parathyroid carcinoma: analysis of an experience of 19 cases. J Surg Oncol 88:223–228
Iacobone M, Barzon L, Porzionato A, Masi G, Macchi V, Marino F, Viel G, Favia G (2007) Parafibromin expression, single-gland involvement, and limited parathyroidectomy in familial isolated hyperparathyroidism. Surgery 142:984–991
Iacobone M, Scarpa M, Lumachi F, Favia G (2005) Are frozen sections useful and cost-effective in the era of intraoperative qPTH assays? Surgery 138:1159–1164
Lumachi F, Ermani M, Marino F, Poletti A, Basso SM, Iacobone M, Favia G (2004) Relationship of AgNOR counts and nuclear DNA content to survival in patients with parathyroid carcinoma. Endocr Relat Cancer 11:563–569
Miccoli P, Pinchera A, Cecchini G, Conte M, Bendinelli C, Vignali E, Picone A, Marcocci C (1997) Minimally invasive, video-assisted parathyroid surgery for primary hyperparathyroidism. J Endocrinol Invest 20:429–430
Ravipati NB, McLemore EC, Schlinkert RT, Argueta R (2008) Anterior mediastinotomy for parathyroidectomy. Am J Surg 195:799–802
Wells SA Jr, Cooper JD (1991) Closed mediastinal exploration in patients with persistent hyperparathyroidism. Ann Surg 214:555–561
Doherty GM, Doppman JL, Miller DL, Gee MS, Marx SJ, Spiegel AM, Aurbach GD, Pass HI, Brennan MF, Norton JA (1992) Results of multidisciplinary strategy for management of mediastinal parathyroid adenoma as a cause of persistent primary hyperparathyroidism. Ann Surg 215:101–106
Profanter C, Schmid T, Prommegger R, Bale R, Sauper T, Bodner J (2004) Robot-assisted mediastinal parathyroidectomy. Surg Endosc 18:868–870
Tcherveniakov P, Menon A, Milton R, Papagiannopoulos K, Lansdown K, Thorpe JAC (2007) Video-assisted mediastinoscopy (VAM) for surgical resection of ectopic parathyroid adenoma. J Cardiothorac Surg 2:41
Heller HJ, Miller GL, Erdman WA, Snyder WH 3rd, Breslau NA (1994) Angiographic ablation of mediastinal parathyroid adenomas: local experience and review of the literature. Am J Med 97:529–534
Di Bisceglie M, Voltolini L, Paladini P, Cacchiarelli M, Vella A, Gotti G (1998) Ectopic parathyroid adenoma: two cases treated with video-assisted thoracoscopic surgery. Scand Cardiovasc J 32:51–52
Author information
Authors and Affiliations
Corresponding author
Additional information
This paper has been presented to the fourth Biennal Congress of the European Association of Endocrine Surgeons (ESES), Vienna (Austria), May 13-15, 2010
Rights and permissions
About this article
Cite this article
Iacobone, M., Mondi, I., Viel, G. et al. The results of surgery for mediastinal parathyroid tumors: a comparative study of 63 patients. Langenbecks Arch Surg 395, 947–953 (2010). https://doi.org/10.1007/s00423-010-0678-2
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00423-010-0678-2