How Does the Operative Strategy for Primary Hyperparathyroidism Impact the Findings and Cure Rate? A Comparison of 800 Parathyroidectomies

McGill, Julie; Sturgeon, Cord; Kaplan, Sharone P.; Chiu, Bill; Kaplan, Edwin L.; Angelos, Peter

doi:10.1016/j.jamcollsurg.2008.01.066

« Previous Next »Journal of the American College of Surgeons
Volume 207, Issue 2 , Pages 246-249, August 2008

How Does the Operative Strategy for Primary Hyperparathyroidism Impact the Findings and Cure Rate? A Comparison of 800 Parathyroidectomies

Julie McGill, MD
- Department of Surgery, Division of Gastrointestinal and Endocrine Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL
Cord Sturgeon, MD, FACS
- Department of Surgery, Division of Gastrointestinal and Endocrine Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL
Sharone P. Kaplan, BS, LSW
- Department of Surgery, Section of General Surgery and Surgical Oncology, University of Chicago, Chicago, IL.
Bill Chiu, MD
- Department of Surgery, Division of Gastrointestinal and Endocrine Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL
Edwin L. Kaplan, MD, FACS
- Department of Surgery, Section of General Surgery and Surgical Oncology, University of Chicago, Chicago, IL.
Peter Angelos, MD, PHD, FACS
- Department of Surgery, Section of General Surgery and Surgical Oncology, University of Chicago, Chicago, IL.
- Correspondence address: Peter Angelos, MD, PhD, FACS, Department of Surgery, Section of General Surgery and Surgical Oncology, University of Chicago Medical Center, 5841 South Maryland Ave, MC 4052, Chicago, IL 60637.

Received 17 December 2007; received in revised form 28 January 2008; accepted 28 January 2008. published online 20 May 2008.

Background

We hypothesized that a higher frequency of multigland disease and higher cure rate would result if routine four-gland exploration (4GL) was used as compared with focused parathyroidectomy (FP) for treatment of primary hyperparathyroidism.

Study Design

During a 5-year period, data from two academic endocrine surgical practices were retrospectively reviewed for patients having an operation for primary hyperparathyroidism. Three hundred ninety-five consecutive patients underwent 4GL at one institution (A), and 405 consecutive patients underwent FP with selective use of 4GL at the other institution (B). The main outcomes measures were gender, preoperative imaging, surgical findings, gland weight, and operative success.

Results

Three hundred ten (78%) patients at institution A were women, and 292 (72%) at institution B were women (p < 0.05). Routine 4GL strategy at institution A yielded a 16.5% frequency of multigland disease; and an FP strategy at institution B yielded 11.1% multigland disease (p = 0.028). At both institutions, single adenomas weighed more than multigland disease. Gland weights were not significantly different between the two institutions. Nine of 395 (2.3%) patients at institution A remained hypercalcemic postoperatively compared with 15 of 405 (3.7%) at B (p = 0.24; not significant).

Conclusions

A greater frequency of multigland disease was found with routine 4GL. There was no statistically significant difference in operative success between the two approaches. Sound surgical technique and intraoperative judgment, including interpretation of intraoperative parathyroid hormone values, will result in a high success rate, regardless of the operative strategy chosen for primary hyperparathyroidism.

Abbreviations and Acronyms: FP, focused parathyroidectomy, IOPTH, intraoperative parathyroid hormone, PTH, parathyroid hormone, 4GL, four-gland exploration