Systematic review of cure and recurrence rates following minimally invasive parathyroidectomy. Issue 6 (28th May 2018)

• Record Type: Journal Article
• Authors: Ishii, H; Mihai, R; Watkinson, J C; Kim, D S
• Is Part Of: BJS open. Volume 2:Issue 6(2018)
• Page Start: 364
• Page End: 370
• Publication Date: 2018-05-28
• Subjects: Surgery -- Periodicals; 617.005
• DOI: 10.1002/bjs5.77
• Languages: English
• ISSNs: 2474-9842

Abstract

Abstract: Background: The majority of patients with primary hyperparathyroidism (PHPT) have a single overactive adenoma. Advances in preoperative imaging and surgical adjuncts have given rise to minimally invasive parathyroidectomy (MIP), with lower complication rates in comparison with bilateral neck exploration. Misdiagnosis and undertreatment of multiglandular disease, leading to potentially higher recurrence rates, remains a concern. This study evaluated risks of long-term (1 year or more) recurrence following 'targeted' MIP in PHPT. Methods: Multiple databases were searched for studies published between January 2004 and March 2017, looking at long-term outcomes (1 year or more) following targeted MIP for PHPT. English-language studies, with at least 50 patients and a mean follow-up of 1 year, were included. Results: A total of 5282 patients from 14 studies were included. Overall mean recurrence and cure rates were 1·6 (range 0–3·5) and 96·9 (95·5–100) per cent respectively. Mean follow-up was 33·5 (1–145) months. When intraoperative parathyroid hormone (PTH) measurements were not done, cure rates were higher (99·3 per cent versus 98·1 per cent with use of intraoperative PTH measurement; P < 0·001) and recurrence rates lower (0·2 versus 1·5 per cent respectively; P < 0·001). Conclusion: Targeted MIP for a presumed single overactive adenoma was associated with very low recurrence rates, without the need for intraoperative PTH measurement when preoperative imaging studies were concordant. Targeted MIP should be encouraged. Graphical Abstract: Minimally invasive parathyroidectomy (MIP) for the surgical management of primary hyperparathyroidism is a robust technique with good cure rates (96.9 per cent) and low recurrence rates (1.56 per cent) after a year or more of follow-up in 5282 patients. This review also suggests that MIP can be highly effective, robust and safe without intraoperative parathyroid hormone assay use in patients with preoperative concordant imaging. Seems a safe strategy