Punam P Parikh1, Josefina C Farra2, Bassan J Allan2, John I Lew2. 1. The DeWitt Daughtry Family Department of Surgery, Division of Surgical Endocrinology, University of Miami Leonard M. Miller School of Medicine, 1120 NW 14th Street, 4th Floor, Clinical Research Building 410P, Miami, FL 33136, USA. Electronic address: pparikh@med.miami.edu. 2. The DeWitt Daughtry Family Department of Surgery, Division of Surgical Endocrinology, University of Miami Leonard M. Miller School of Medicine, 1120 NW 14th Street, 4th Floor, Clinical Research Building 410P, Miami, FL 33136, USA.
Abstract
BACKGROUND: Reoperative parathyroidectomy (RPTX) for persistent or recurrent hyperparathyroidism is associated with a high rate of operative failure. The long-term effectiveness of RPTX using localization studies and intraoperative parathormone monitoring (IPM) was examined. METHODS: Retrospective analysis of prospectively collected data from patients undergoing targeted RPTX with IPM for persistent or recurrent hyperparathyroidism was performed. Persistent hyperparathyroidism was defined as elevated calcium and parathormone (PTH) levels above normal range less than 6 months after parathyroidectomy. Recurrent hyperparathyroidism was defined as elevated calcium and PTH levels greater than 6 months after successful parathyroidectomy. Sensitivity and positive predictive value (PPV) for sestamibi, surgeon-performed ultrasound, intraoperative PTH dynamics, and surgical outcomes were evaluated. RESULTS: Of the 1,064 patients, 69 patients underwent 72 RPTXs with localizing studies and IPM. Sestamibi (n = 69) had a sensitivity of 74% and a PPV of 83%, whereas surgeon-performed ultrasound (n = 38) had a sensitivity of 55% and a PPV of 76%. IPM had a sensitivity of 100% and a PPV of 98%. An intraoperative PTH drop greater than or equal to 50% was predictive of operative success (P < .01). Overall, operative success and recurrence were 94% and 1.4%, with a mean patient follow-up of 59 ± 12.8 months. CONCLUSION: RPTX can be performed in a targeted approach using preoperative localization studies and IPM, leading to a low rate of complications and a high rate of long-term operative success.
BACKGROUND: Reoperative parathyroidectomy (RPTX) for persistent or recurrent hyperparathyroidism is associated with a high rate of operative failure. The long-term effectiveness of RPTX using localization studies and intraoperative parathormone monitoring (IPM) was examined. METHODS: Retrospective analysis of prospectively collected data from patients undergoing targeted RPTX with IPM for persistent or recurrent hyperparathyroidism was performed. Persistent hyperparathyroidism was defined as elevated calcium and parathormone (PTH) levels above normal range less than 6 months after parathyroidectomy. Recurrent hyperparathyroidism was defined as elevated calcium and PTH levels greater than 6 months after successful parathyroidectomy. Sensitivity and positive predictive value (PPV) for sestamibi, surgeon-performed ultrasound, intraoperative PTH dynamics, and surgical outcomes were evaluated. RESULTS: Of the 1,064 patients, 69 patients underwent 72 RPTXs with localizing studies and IPM. Sestamibi (n = 69) had a sensitivity of 74% and a PPV of 83%, whereas surgeon-performed ultrasound (n = 38) had a sensitivity of 55% and a PPV of 76%. IPM had a sensitivity of 100% and a PPV of 98%. An intraoperative PTH drop greater than or equal to 50% was predictive of operative success (P < .01). Overall, operative success and recurrence were 94% and 1.4%, with a mean patient follow-up of 59 ± 12.8 months. CONCLUSION: RPTX can be performed in a targeted approach using preoperative localization studies and IPM, leading to a low rate of complications and a high rate of long-term operative success.
Authors: Serena Grimaldi; Jacques Young; Peter Kamenicky; Dana Hartl; Marie Terroir; Sophie Leboulleux; Amandine Berdelou; Julien Hadoux; Segolene Hescot; Hervé Remy; Eric Baudin; Martin Schlumberger; Désirée Deandreis Journal: Eur J Nucl Med Mol Imaging Date: 2018-04-22 Impact factor: 9.236
Authors: C Camenzuli; A N DiMarco; K E Isaacs; Y Grant; J Jackson; A Alsafi; C Harvey; T D Barwick; N Tolley; F F Palazzo Journal: Ann R Coll Surg Engl Date: 2020-08-24 Impact factor: 1.891