Focused parathyroidectomy without intraoperative parathyroid
The study shows equivalent cure rates with focused parathyroidectomy for primary hyperparathyroidism without intraoperative parathyroid hormone estimation and with open bilateral neck exploration.

This study explores whether focused parathyroidectomy for radiologically localized primary hyperparathyroidism without intraoperative parathyroid hormone is still a valid approach.

All parathyroidectomies for primary hyperparathyroidism over 6 years were included. Lithium-induced hyperparathyroidism, reoperations, familial disease, and concurrent thyroid surgery were excluded. Characteristics and outcomes for focused parathyroidectomy and open bilateral neck exploration were compared by intention-to-treat and treatment delivered. Persistence and recurrence, conversions, and complications were analyzed as endpoints.

A total of 2,828 parathyroidectomies were performed and 2,421 analyzed. By intention to treat there were 1,409 focused parathyroidectomies and 1,012 open bilateral neck explorations. Focused parathyroidectomy patients were younger: 63 vs 66 years; however, gender, preoperative peak serum calcium, and serum parathyroid hormone did not differ.

In total, 229 focused parathyroidectomies were converted to open bilateral neck exploration. Multiple gland disease was confirmed in 54.5% of converted patients. The Median follow-up was 41 months.

- Persistence or recurrence requiring reoperation totaled 2.2% and did not differ between focused parathyroidectomy and open bilateral neck exploration in either intention to treat or final treatment analyses.

- Complications occurred in 1.2% of focused parathyroidectomy and 3.2% open bilateral neck exploration.

To summarize, in experienced hands and with a ready-selective approach to conversion, focused parathyroidectomy based on concordant imaging and without intraoperative parathyroid hormone may deliver equivalent cure rates to open bilateral neck exploration with significantly fewer complications. Focused parathyroidectomy without intraoperative parathyroid hormone should therefore be maintained in the endocrine surgeon’s armamentarium.

Surgery
Source: https://doi.org/10.1016/j.surg.2021.05.030
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Dr. P●●●●●●●●i S●●●●●●●●●●n General Surgery
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