Mark Thier1,2, Erik Nordenström3, Martin Almquist3, Anders Bergenfelz3. 1. Department of Clinical Sciences, Lund University, Lund, Sweden. mark.thier@skane.se. 2. Department of Surgery, Skane University Hospital, Lund University, 221 85, Lund, Sweden. mark.thier@skane.se. 3. Department of Clinical Sciences, Lund University, Lund, Sweden.
Abstract
BACKGROUND: Since the introduction of unilateral parathyroidectomy for primary hyperparathyroidism (pHPT) it has been debated wherever this approach is associated with greater long-term risk for recurrence compared to bilateral neck exploration. METHODS: This is a prospective study based on a structured 15-year follow-up program in patients with non-hereditary, sporadic pHPT, undergoing first time surgery with unilateral or focused neck exploration (unilateral procedures), with the use of intraoperative PTH (iOPTH) between 1989 and 2010. RESULTS: 292 patients were analyzed. The median age of the patients was 66 years [interquartile range (IQR) 57-75], and 234 (80.4%) were female. The median preoperative level of total calcium was 2.74 mmol/L (IQR 2.63-2.85 mmol/L) and the median PTH level was 10 pmol/L (IQR 7.4-14 pmol/L). The median follow-up time was 5 years (IQR 1-10 years). Some 275 patients were followed for 1 year (94.2%/275 person-years/5 patients deceased), 164 for 5 years (56.2%/820 person-years/31 patients deceased), 70 for 10 years (24.0%/700 patient-years/57 patients deceased) and 51 (17.5%/765 patient-years/69 patients deceased) for 15 years after surgery. Three patients (1.1%) had signs of persistent disease. One patient recurred in pHPT at 5 years postoperatively during 15 years of follow-up. Histopathology indicated solitary parathyroid adenoma at primary surgery. CONCLUSION: Patients with pHPT operated with unilateral procedures and iOPTH, had a low risk for long-term recurrence during a 15 years follow-up program.
BACKGROUND: Since the introduction of unilateral parathyroidectomy for primary hyperparathyroidism (pHPT) it has been debated wherever this approach is associated with greater long-term risk for recurrence compared to bilateral neck exploration. METHODS: This is a prospective study based on a structured 15-year follow-up program in patients with non-hereditary, sporadic pHPT, undergoing first time surgery with unilateral or focused neck exploration (unilateral procedures), with the use of intraoperative PTH (iOPTH) between 1989 and 2010. RESULTS: 292 patients were analyzed. The median age of the patients was 66 years [interquartile range (IQR) 57-75], and 234 (80.4%) were female. The median preoperative level of total calcium was 2.74 mmol/L (IQR 2.63-2.85 mmol/L) and the median PTH level was 10 pmol/L (IQR 7.4-14 pmol/L). The median follow-up time was 5 years (IQR 1-10 years). Some 275 patients were followed for 1 year (94.2%/275 person-years/5 patients deceased), 164 for 5 years (56.2%/820 person-years/31 patients deceased), 70 for 10 years (24.0%/700 patient-years/57 patients deceased) and 51 (17.5%/765 patient-years/69 patients deceased) for 15 years after surgery. Three patients (1.1%) had signs of persistent disease. One patient recurred in pHPT at 5 years postoperatively during 15 years of follow-up. Histopathology indicated solitary parathyroid adenoma at primary surgery. CONCLUSION:Patients with pHPT operated with unilateral procedures and iOPTH, had a low risk for long-term recurrence during a 15 years follow-up program.
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