Operative failure in the era of focused parathyroidectomy: a contemporary series of 845 patients.

Abstract

HYPOTHESIS:

Focused parathyroidectomy guided by intraoperative parathyroid hormone monitoring (IPM) may lead to higher failure rates because of missed multiglandular disease.

DESIGN:

Retrospective review of prospectively collected data.

SETTING:

Tertiary referral center.

PATIENTS:

From September 8, 1993, through January 30, 2009, a total of 845 consecutive patients with sporadic primary hyperparathyroidism underwent focused parathyroidectomy guided by IPM at a single institution.

MAIN OUTCOME MEASURES:

Parathyroid hormone dynamics and perioperative data were analyzed for factors affecting outcome. Operative failure was defined as hypercalcemia with elevated parathyroid hormone levels within 6 months after parathyroidectomy. Detailed intraoperative data from the failed operations were also reviewed.

RESULTS:

Of 723 patients followed up for at least 6 months, 702 (97.1%) had successful parathyroidectomy, and 21 (2.9%) had failed parathyroidectomy. The major cause of operative failure was the surgeon's inability to find the abnormal parathyroid gland (16 of 21 patients [76.2%]). In the remaining patients, IPM results were false-positive in 5 of 21 patients (23.8%) or 0.7% overall. Among the cohort, IPM correctly identified missed multiglandular disease in 33 of 38 patients (86.8%). Patients having operative failure were more likely to have a history of thyroidectomy or parathyroidectomy and were less likely to have correct findings on technetium Tc 99m sestamibi or ultrasonographic localizing studies compared with patients having operative success.

CONCLUSION:

Inability of the surgeon to find the abnormal parathyroid gland-not missed multiglandular disease-is the main cause of operative failure in focused parathyroidectomy guided by IPM.

• Authors: John I Lew, Mariela Rivera, George L Irvin 3rd, Carmen C Solorzano
• Journal: Archives of surgery (Chicago, Ill. : 1960) (Arch Surg) Vol. 145 Issue 7 Pg. 628-33 (Jul 2010) ISSN: 1538-3644 [Electronic] United States
• PMID: 20644124 (Publication Type: Journal Article)

Chemical References

• Biomarkers, Tumor
• Parathyroid Hormone

Topics

• Aged
• Biomarkers, Tumor (blood)
• Female
• Humans
• Hypercalcemia (blood, diagnosis)
• Hyperparathyroidism, Primary (pathology, surgery)
• Male
• Middle Aged
• Monitoring, Intraoperative (methods)
• Parathyroid Hormone (blood)
• Parathyroidectomy (methods)
• Predictive Value of Tests
• Prospective Studies
• Retrospective Studies
• Treatment Failure