Prior head and neck radiation exposure is not a contraindication to minimally invasive parathyroidectomy.

Abstract

BACKGROUND:

Most patients with primary hyperparathyroidism can have a minimally invasive parathyroidectomy based on localization studies showing single-gland disease. In patients with a history of head and neck irradiation, due to the increased risk of multigland disease and risk of concurrent thyroid cancer, minimally invasive parathyroidectomy is considered by some to be a contraindication. We postulated that previous history of head and neck irradiation should not be a contraindication for minimally invasive parathyroidectomy and tested this hypothesis in a prospective cohort of patients undergoing parathyroidectomy for primary hyperparathyroidism.

STUDY DESIGN:

We performed a retrospective analysis of a prospective database of 491 consecutive parathyroidectomies performed between May 2005 and May 2007 at a tertiary referral medical center.

RESULTS:

Fifty-two (12.6%) patients had a history of head and neck irradiation and 360 (87.4%) had no exposure to radiation. The 2 groups had no significant difference in terms of gender or ethnicity. The radiation group was older, with an average age of 65.1 years versus 58.1 years (p < 0.0009). There was no significant difference in concurrent benign thyroid neoplasm, thyroid cancer, and type of parathyroid disease (single vs multigland) in the 2 groups. There was no significant difference in the operative approach used between the 2 groups (focused vs unilateral or bilateral).

CONCLUSIONS:

Head and neck irradiation should not be a contraindication for minimally invasive parathyroidectomy in patients with primary hyperparathyroidism in the setting of preoperative localization studies showing single-gland disease and no concurrent thyroid neoplasm. Furthermore, history of head and neck irradiation is associated with a later age of presentation for parathyroidectomy.

• Authors: Reza Rahbari, Ileana G Sansano, Dina M Elaraj, Quan-Yang Duh, Orlo H Clark, Electron Kebebew
• Journal: Journal of the American College of Surgeons (J Am Coll Surg) Vol. 210 Issue 6 Pg. 942-8 (Jun 2010) ISSN: 1879-1190 [Electronic] United States
• PMID: 20510803 (Publication Type: Journal Article)
• Copyright: Published by Elsevier Inc.

Topics

• Aged
• Contraindications
• Female
• Head and Neck Neoplasms (diagnostic imaging, radiotherapy)
• Humans
• Hyperparathyroidism, Primary (diagnostic imaging, surgery)
• Male
• Middle Aged
• Parathyroidectomy
• Radionuclide Imaging
• Radiotherapy (adverse effects)
• Recurrence
• Retrospective Studies
• Statistics, Nonparametric
• Surveys and Questionnaires
• Thyroid Neoplasms (diagnostic imaging, radiotherapy)
• Treatment Outcome
• Ultrasonography