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Systematic review of cure and recurrence rates following minimally invasive parathyroidectomy

Ishii, H; Mihai, R; Watkinson, JC; Kim, DS (2018) Systematic review of cure and recurrence rates following minimally invasive parathyroidectomy. BJS OPEN, 2 (6). pp. 364-370. ISSN 2474-9842 https://doi.org/10.1002/bjs5.77
SGUL Authors: Kim, Dae Sung

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Abstract

Background The majority of patients with primary hyperparathyroidism (PHPT) have a single overactive adenoma. Advances in preoperative imaging and surgical adjuncts have given rise to minimally invasive parathyroidectomy (MIP), with lower complication rates in comparison with bilateral neck exploration. Misdiagnosis and undertreatment of multiglandular disease, leading to potentially higher recurrence rates, remains a concern. This study evaluated risks of long‐term (1 year or more) recurrence following ‘targeted’ MIP in PHPT. Methods Multiple databases were searched for studies published between January 2004 and March 2017, looking at long‐term outcomes (1 year or more) following targeted MIP for PHPT. English‐language studies, with at least 50 patients and a mean follow‐up of 1 year, were included. Results A total of 5282 patients from 14 studies were included. Overall mean recurrence and cure rates were 1·6 (range 0–3·5) and 96·9 (95·5–100) per cent respectively. Mean follow‐up was 33·5 (1–145) months. When intraoperative parathyroid hormone (PTH) measurements were not done, cure rates were higher (99·3 per cent versus 98·1 per cent with use of intraoperative PTH measurement; P < 0·001) and recurrence rates lower (0·2 versus 1·5 per cent respectively; P < 0·001). Conclusion Targeted MIP for a presumed single overactive adenoma was associated with very low recurrence rates, without the need for intraoperative PTH measurement when preoperative imaging studies were concordant. Targeted MIP should be encouraged.

Item Type: Article
Additional Information: © 2018 The Authors. BJS Open published by John Wiley & Sons Ltd on behalf of BJS Society Ltd This is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.
SGUL Research Institute / Research Centre: Academic Structure > Institute of Medical & Biomedical Education (IMBE)
Academic Structure > Institute of Medical & Biomedical Education (IMBE) > Centre for Clinical Education (INMECE )
Journal or Publication Title: BJS OPEN
ISSN: 2474-9842
Dates:
DateEvent
26 November 2018Published
28 May 2018Published Online
3 April 2018Accepted
Publisher License: Creative Commons: Attribution 4.0
Web of Science ID: WOS:000451116800001
URI: https://openaccess.sgul.ac.uk/id/eprint/110467
Publisher's version: https://doi.org/10.1002/bjs5.77

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