Parathyroidectomy Results in Primary Hyperparathyroidism: Analysis of the Results From a Single Center

Mehmet Taner Unlu; Nurcihan Aygun; Ismail Ethem Akgun; Sitki Gurkan Yetkin; Rumeysa Selvinaz Erol; Adnan Isgor; Mehmet Uludag

doi:10.14744/SEMB.2021.72681

Parathyroidectomy Results in Primary Hyperparathyroidism: Analysis of the Results From a Single Center

Sisli Etfal Hastan Tip Bul. 2021 Jul 2;55(2):173-178. doi: 10.14744/SEMB.2021.72681. eCollection 2021.

Authors

Mehmet Taner Unlu¹, Nurcihan Aygun², Ismail Ethem Akgun², Sitki Gurkan Yetkin², Rumeysa Selvinaz Erol³, Adnan Isgor⁴, Mehmet Uludag²

Affiliations

¹ Department of General Surgery, Basaksehir Cam and Sakura City Hospital, Istanbul, Turkey.
² Department of General Surgery, University of Health Sciences Turkey, Sisli Hamidiye Etfal Teaching and Research Hospital, Istanbul, Turkey.
³ Division of Endocrinology and Metabolism, Department of Internal Medicine, University of Health Sciences Turkey, Sisli Hamidiye Etfal Teaching and Research Hospital, Istanbul, Turkey.
⁴ Department of General Surgery, Bahcesehir University Faculty of Medicine, Istanbul, Turkey.

Abstract

Objectives: The curative treatment of primary hyperparathyroidism (PHPT) is surgery. Persistent and recurrent disease may develop after surgical treatment. In this study, we aimed to evaluate the surgical cure rate in patients who underwent surgery for PHPT in our clinic.

Methods: The data of patients who underwent parathyroidectomy for PHPT by two experienced surgeons between 2000 and 2015 in our clinic were retrospectively evaluated. Patients who were followed for at least 6 months after their first parathyroidectomy were included in the study. Surgical cure and persistent and recurrent disease rates were evaluated in patients.

Results: During this period, 368 interventions were performed in 357 patients (293 F and 64 M) who were operated for PHPT in our clinic, with a mean age of 54.9±13.1 years. In the first surgery, 116 patients (32.5%) had bilateral neck exploration, 251 patients (67.5%) had unilateral neck exploration (UNE) or focused parathyroid surgery (FPS). In the first operation, 343 patients (96.1%) had cure, 14 patients (13 F and 1 M) remained persistent. Secondary surgical intervention was performed in 11 patients. UNE or FPS was performed to 10 patients (90.9%); partial sternotomy was performed to one patient. Ten of the patients had cure. Three of these patients had a solitary parathyroid adenoma that was not removed in the first surgery, and seven patients had a second adenoma. Four patients remained persistent (1.1%). Recurrent disease developed in four patients during follow-up (1.1%). Total cure rate was 97.8%.

Conclusion: The only definitive treatment for PHPT is surgery. High surgical cure can be achieved by pre-operative evaluation and appropriate surgical planning. However, persistent PHPT may develop, especially due to double adenoma or ectopic location. Patients with persistent PHPT can be evaluated with repeat imaging methods and with appropriate surgical planning, a high cure rate can be obtained in secondary surgery, which can increase the total surgical cure rate. Recurrence rate is rare.

Keywords: Hyperparathyroidism; parathyroidectomy; persistent disease; recurrent disease.