Outcomes Of Subtotal Parathyroidectomy Versus Total Parathyroidectomy With Autotransplantation For Tertiary Hyperparathyroidism: Multi-instutional Study.
*Woong Y Chung1, *Mohamed A Aboueisha2, *Abdallah S. Attia2, *Mahmoud Omar2, *Ahmad ELnahla2, *Eman A Toraih2, *Mohamed Shama2, *Ryeon Choi1, *Jong J Jeong3, Emad Kandil2
1Department of Surgery, Yonsei University College of Medicine, Seoul, Korea, Democratic People's Republic of2Tulane School of Medicine, Surgery Department, New Orleans, LA;3Department of Surgery, Yonsei University College of Medicine, Seoul, Korea, Republic of
Due to the paucity of data and controversy regarding the preferred surgical approach for managing tertiary hyperparathyroidism, we sought to investigate the outcomes of different surgical approaches in managing this challenging disease.
We performed a multi-center retrospective study to include patients with tertiary hyperparathyroidism who underwent subtotal parathyroidectomy (SPT) or total parathyroidectomy with auto-transplantation (TPTA).
A total of 148 patients were included. Sixty-eight patients underwent SPT, and eighty patients underwent TPTA, with a mean age of 48.90±1.56 years and 49.52±1.21 years, respectively. Patients who underwent TPTA procedure had a more extended mean hospital stay of 9.8 days. At 12-month follow-up, the mean Ca level was 9.13±1.2 mg/dl mg/dl for the SPT group vs 8.89±1.02 mg/dl in the TPTA group, p=0.169. The PTH level was 161.77± 50.9 pg/ml for the SPT group compared to 111.9± 24.49 pg/ml for the TPTA group, p= 0.282. Postoperative hypocalcemia was more common in TPTA group with a rate of 21.3% compared to 17.6% with SPT group.
CONCLUSIONS: To our knowledge, this is the largest multicenter study that compared different approaches for managing tertiary hyperparathyroidism. Curative rates were comparable, however, total parathyroidectomy with auto-transplantation can lead to a longer hospital stay and is associated with a higher rate of postoperative hypocalcemia. Further future prospective studies are warranted.
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