Long-term results of less than total parathyroidectomy for hyperparathyroidism in multiple endocrine neoplasia type 1

Surgery. 2002 Dec;132(6):1119-24; discussion 1124-5. doi: 10.1067/msy.2002.128607.

Abstract

Background: Our aim was to assess long-term results after less than total parathyroidectomy for hyperparathyroidism in multiple endocrine neoplasia type 1.

Methods: Of 1888 patients undergoing operation at our institution for primary hyperparathyroidism between 1972 and 2001, 83 (4.4%) had multiple endocrine neoplasia type 1. Outcome data were available for 79; 66 underwent subtotal parathyroidectomy, 55 (83%) of these with bilateral thymectomy. In 13 patients, only grossly enlarged glands were resected (mean 1.1 per patient) as the syndrome of multiple endocrine neoplasia type 1 was not yet evident or the initial exploration was performed elsewhere.

Results: Follow-up has been 48 +/- 51 months (mean + SD). Intraoperative serum PTH assay decay in 20 patients was suggestive of cure in 18 patients, none of whom required reoperation. Nine patients (11%) required reoperation (3 required reoperation twice) after a mean interval of 77 +/- 53 months. Subtotal parathyroidectomy resulted in a lesser reoperation rate than resection of grossly enlarged glands (7% vs 30%, P =.02). At the time of review, 63 patients (80%) were normocalcemic, 10 (13%) hypocalcemic (2 after unsuccessful delayed autograft), and 7% hypercalcemic (none after reoperation). By Kaplan-Meier analysis, the rate of surgical cure (patients who are nonhypercalcemic) is 60% and 51% at 10 and 15 years, respectively.

Conclusion: Subtotal parathyroidectomy reduces the need for reoperation. Selective reoperation leads to long-lasting biochemic cure.

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Calcium / blood
  • Female
  • Follow-Up Studies
  • Humans
  • Hypercalcemia / etiology
  • Hypercalcemia / surgery
  • Hyperparathyroidism / etiology*
  • Hyperparathyroidism / surgery*
  • Male
  • Middle Aged
  • Multiple Endocrine Neoplasia Type 1 / complications*
  • Parathyroidectomy / methods*
  • Postoperative Complications
  • Reoperation
  • Treatment Outcome
  • Zollinger-Ellison Syndrome / etiology
  • Zollinger-Ellison Syndrome / surgery

Substances

  • Calcium