S C V Paravastu1, D R Chadwick. 1. Academic Vascular Unit, University of Sheffield, Sheffield S1 4DA, UK. sharathparavastu@gmail.com
Abstract
AIM: To determine the outcomes of bilateral neck exploration (BNE) and uptake as well as outcomes of minimally invasive parathyroidectomy (MIP) for primary hyperparathyroidism in a district general hospital (DGH). METHODS: Patients who underwent first-time parathyroidectomy for primary hyperparathyroidism between August 1999 and December 2010 were identified from a prospectively maintained database of a single surgeon and were analysed for outcomes of MIP and BNE. MIP was adopted in 2006 and prior to that all patients underwent BNE. Results were analysed on an intention-to-treat basis. RESULTS: A total of 368 patients underwent parathyroid surgery; BNE (n = 314) and MIP (n = 54). Overall cure rate was 97%. Intention-to-treat analysis, based on surgical approach, showed cure rates of 96.5% with BNE and 96.3% with MIP (p = 1.0). Of the 92 patients assessed for MIP, localisation by ultrasound and sestamibi were noted in 60 (65%) and 65 (71%) patients respectively; however, concordance between the scans was noted in only 54 (59%) patients. Of the 54 patients who underwent MIP, 5 (9.2%) were converted to BNE. Intention-to-treat analysis, based on preoperative imaging, showed cure rates of 96% with BNE and 98% with MIP (p = 0.53). CONCLUSIONS: Satisfactory cure rates for parathyroidectomy are achievable in a 'medium-volume' endocrine unit within a DGH. Preoperative localisation studies with USS and MIBI have a positive concordance rate in only 60% of those considered for MIP, thereby limiting the use of MIP and reinforcing the role of BNE in this era of minimally invasive surgery. Crown
AIM: To determine the outcomes of bilateral neck exploration (BNE) and uptake as well as outcomes of minimally invasive parathyroidectomy (MIP) for primary hyperparathyroidism in a district general hospital (DGH). METHODS:Patients who underwent first-time parathyroidectomy for primary hyperparathyroidism between August 1999 and December 2010 were identified from a prospectively maintained database of a single surgeon and were analysed for outcomes of MIP and BNE. MIP was adopted in 2006 and prior to that all patients underwent BNE. Results were analysed on an intention-to-treat basis. RESULTS: A total of 368 patients underwent parathyroid surgery; BNE (n = 314) and MIP (n = 54). Overall cure rate was 97%. Intention-to-treat analysis, based on surgical approach, showed cure rates of 96.5% with BNE and 96.3% with MIP (p = 1.0). Of the 92 patients assessed for MIP, localisation by ultrasound and sestamibi were noted in 60 (65%) and 65 (71%) patients respectively; however, concordance between the scans was noted in only 54 (59%) patients. Of the 54 patients who underwent MIP, 5 (9.2%) were converted to BNE. Intention-to-treat analysis, based on preoperative imaging, showed cure rates of 96% with BNE and 98% with MIP (p = 0.53). CONCLUSIONS: Satisfactory cure rates for parathyroidectomy are achievable in a 'medium-volume' endocrine unit within a DGH. Preoperative localisation studies with USS and MIBI have a positive concordance rate in only 60% of those considered for MIP, thereby limiting the use of MIP and reinforcing the role of BNE in this era of minimally invasive surgery. Crown
Authors: Joseph M Pappachan; Mohamed Nabil Elnaggar; Ravinder Sodi; Kahtan Jbeili; Paul R Smith; Ian M Lahart Journal: Endocrine Date: 2018-07-17 Impact factor: 3.633