-
Tytuł:
-
Recurrence after successful parathyroidectomy-Who should we worry about?
-
Autorzy:
-
Shirali AS; University of Texas MD Anderson Cancer Center, Department of Surgical Oncology, Houston, TX. Electronic address: https://twitter.com/AdityaShiraliMD.
Wu SY; University of Texas MD Anderson Cancer Center, Department of Surgical Oncology, Houston, TX; Division of General Surgery, Department of Surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan. Electronic address: https://twitter.com/fiftyonedollars.
Chiang YJ; University of Texas MD Anderson Cancer Center, Department of Surgical Oncology, Houston, TX.
Graham PH; University of Texas MD Anderson Cancer Center, Department of Surgical Oncology, Houston, TX.
Grubbs EG; University of Texas MD Anderson Cancer Center, Department of Surgical Oncology, Houston, TX. Electronic address: https://twitter.com/EGrubbsMD.
Lee JE; University of Texas MD Anderson Cancer Center, Department of Surgical Oncology, Houston, TX.
Perrier ND; University of Texas MD Anderson Cancer Center, Department of Surgical Oncology, Houston, TX. Electronic address: https://twitter.com/DrNancyPerrier.
Fisher SB; University of Texas MD Anderson Cancer Center, Department of Surgical Oncology, Houston, TX. Electronic address: .
-
Źródło:
-
Surgery [Surgery] 2022 Jan; Vol. 171 (1), pp. 40-46. Date of Electronic Publication: 2021 Jul 31.
-
Typ publikacji:
-
Journal Article
-
Język:
-
English
-
Imprint Name(s):
-
Publication: St. Louis, MO : Mosby
Original Publication: St. Louis.
-
MeSH Terms:
-
Hypercalcemia/*surgery
Hyperparathyroidism, Primary/*surgery
Minimally Invasive Surgical Procedures/*statistics & numerical data
Parathyroidectomy/*statistics & numerical data
Aged ; Calcium/blood ; Female ; Follow-Up Studies ; Humans ; Hypercalcemia/blood ; Hypercalcemia/diagnosis ; Hypercalcemia/epidemiology ; Hyperparathyroidism, Primary/blood ; Hyperparathyroidism, Primary/diagnosis ; Hyperparathyroidism, Primary/epidemiology ; Male ; Middle Aged ; Parathyroid Hormone/blood ; Parathyroidectomy/methods ; Recurrence ; Retrospective Studies ; Risk Assessment/methods ; Risk Assessment/statistics & numerical data ; Treatment Outcome
-
Substance Nomenclature:
-
0 (Parathyroid Hormone)
SY7Q814VUP (Calcium)
-
Entry Date(s):
-
Date Created: 20210803 Date Completed: 20220218 Latest Revision: 20220218
-
Update Code:
-
20240105
-
DOI:
-
10.1016/j.surg.2021.06.035
-
PMID:
-
34340820
-
Background: Preventing cervical reoperations is important-especially after parathyroidectomy. We sought to examine early predictors of recurrence of primary hyperparathyroidism after surgical cure.
Methods: Adult patients with sporadic primary hyperparathyroidism treated with parathyroidectomy between September 1, 1997, and September 1, 2019, with confirmed eucalcemia at 6 months postoperatively were identified. Recurrence was defined as hypercalcemia (>10.2 mg/dL) with an elevated or nonsuppressed parathyroid hormone level on subsequent follow-up.
Results: Parathyroidectomy was performed in 522 patients (median age, 62.1 years, 77% female) with the majority undergoing planned minimally invasive parathyroidectomy (85.4%, n = 446). After a median follow-up of 30.9 months, 13 patients (2.5%) recurred (median time to recurrence 50.2 months, interquartile range 27.9-66.5), all of whom underwent planned minimally invasive parathyroidectomy (n = 13/446, 2.9%). Recurrence was more common in those with higher (but still normal) 6-month calcium (10.1 vs 9.3 mg/dL, P < .001) or parathyroid hormone values (64 vs 46 pg/mL, P < .01). Multivariate analysis revealed that age >66.5 years, calcium ≥9.8mg/dL and parathyroid hormone ≥80 pg/mL at 6 months were associated with increased risk of recurrence. In addition, the presence of at least 1 preoperative imaging study that conflicted with intraoperative findings among minimally invasive parathyroidectomy patients (n = 446) was associated with increased risk of recurrence (hazard ratio 4.93, 95% confidence interval 1.25-16.53, P = .016).
Conclusion: Recurrence of sporadic primary hyperparathyroidism after initial surgical cure in the era of minimally invasive parathyroidectomy is 2.5%. Identification of those at risk for recurrence using 6-month serum calcium ≥9.8 mg/dL, parathyroid hormone ≥80 pg/mL, and/or potentially conflicting localization studies may inform surveillance strategies.
(Copyright © 2021 Elsevier Inc. All rights reserved.)
Comment in: Surgery. 2022 Jan;171(1):46. (PMID: 34340824)
