Damien Bouriez1, Caroline Gronnier1, Magalie Haissaguerre2, Antoine Tabarin2, Haythem Najah3. 1. Digestive and Endocrine Surgery Department, Magellan Center, Bordeaux University Hospital, University of Bordeaux, Bordeaux, France. 2. Endocrinology Department, INSERM Unit 1215, Bordeaux University Hospital, University of Bordeaux, Bordeaux, France. 3. Digestive and Endocrine Surgery Department, Magellan Center, Bordeaux University Hospital, University of Bordeaux, Bordeaux, France. haythem.najah@gmail.com.
Abstract
BACKGROUND: Multiple endocrine neoplasia type 1 (MEN1)-associated primary hyperparathyroidism (pHPT) is classically associated with an asymmetric and asynchronous parathyroid involvement. Subtotal parathyroidectomy (STP), which is currently the recommended surgical treatment, carries a high risk of permanent hypoparathyroidism. The results of less than subtotal parathyroidectomy (LSTP) are conflicting, and its place in this setting is still a matter of debate. The aim of this study was to identify the place of LSTP in the surgical management of patients with MEN-associated pHPT. METHODS: A systematic literature review was conducted in accordance with PRISMA and MOOSE guidelines, for studies comparing STP and LSTP for MEN1-associated pHPT. The results of the two techniques, regarding permanent hypoparathyroidism, persistent hyperparathyroidism and recurrent hyperparathyroidism were computed using pairwise random-effect meta-analysis. RESULTS: Twenty-five studies comparing STP and LSTP qualified for inclusion in the quantitative synthesis. In total, 947 patients with MEN1-associated pHPT were allocated to STP (n = 569) or LSTP (n = 378). LSTP reduces the risk of permanent hypoparathyroidism [odds ratio (OR) 0.29, confidence interval (CI) 95% 0.17-0.49)], but exposes to higher rates of persistent hyperparathyroidism [OR 4.60, 95% CI 2.66-7.97]. Rates of recurrent hyperparathyroidism were not significantly different between the two groups [OR 1.26, CI 95% 0.83-1.91]. CONCLUSIONS: LSTP should not be abandoned and should be considered as a suitable surgical option for selected patients with MEN1-associated pHPT. The increased risk of persistent hyperparathyroidism could improve with the emergence of more efficient preoperative localization imaging techniques and a more adequate patients selection.
BACKGROUND: Multiple endocrine neoplasia type 1 (MEN1)-associated primary hyperparathyroidism (pHPT) is classically associated with an asymmetric and asynchronous parathyroid involvement. Subtotal parathyroidectomy (STP), which is currently the recommended surgical treatment, carries a high risk of permanent hypoparathyroidism. The results of less than subtotal parathyroidectomy (LSTP) are conflicting, and its place in this setting is still a matter of debate. The aim of this study was to identify the place of LSTP in the surgical management of patients with MEN-associated pHPT. METHODS: A systematic literature review was conducted in accordance with PRISMA and MOOSE guidelines, for studies comparing STP and LSTP for MEN1-associated pHPT. The results of the two techniques, regarding permanent hypoparathyroidism, persistent hyperparathyroidism and recurrent hyperparathyroidism were computed using pairwise random-effect meta-analysis. RESULTS: Twenty-five studies comparing STP and LSTP qualified for inclusion in the quantitative synthesis. In total, 947 patients with MEN1-associated pHPT were allocated to STP (n = 569) or LSTP (n = 378). LSTP reduces the risk of permanent hypoparathyroidism [odds ratio (OR) 0.29, confidence interval (CI) 95% 0.17-0.49)], but exposes to higher rates of persistent hyperparathyroidism [OR 4.60, 95% CI 2.66-7.97]. Rates of recurrent hyperparathyroidism were not significantly different between the two groups [OR 1.26, CI 95% 0.83-1.91]. CONCLUSIONS: LSTP should not be abandoned and should be considered as a suitable surgical option for selected patients with MEN1-associated pHPT. The increased risk of persistent hyperparathyroidism could improve with the emergence of more efficient preoperative localization imaging techniques and a more adequate patients selection.
Authors: Jennifer M J Schreinemakers; Carolina R C Pieterman; Anouk Scholten; Menno R Vriens; Gerlof D Valk; Inne H M Borel Rinkes Journal: World J Surg Date: 2011-09 Impact factor: 3.352
Authors: D F Stroup; J A Berlin; S C Morton; I Olkin; G D Williamson; D Rennie; D Moher; B J Becker; T A Sipe; S B Thacker Journal: JAMA Date: 2000-04-19 Impact factor: 56.272
Authors: Trisha Dwight; Anne E Nelson; George Theodosopoulos; Anne Louise Richardson; Diana L Learoyd; Jeanette Philips; Leigh Delbridge; Jan Zedenius; Bin T Teh; Catharina Larsson; Deborah J Marsh; Bruce G Robinson Journal: Am J Pathol Date: 2002-10 Impact factor: 4.307
Authors: Jeffrey A Norton; David J Venzon; Marc J Berna; H R Alexander; Douglas L Fraker; Stephen K Libutti; Stephen J Marx; Fathia Gibril; Robert T Jensen Journal: Ann Surg Date: 2008-03 Impact factor: 12.969
Authors: Dolores M Shoback; John P Bilezikian; Aline G Costa; David Dempster; Henning Dralle; Aliya A Khan; Munro Peacock; Marco Raffaelli; Barbara C Silva; Rajesh V Thakker; Tamara Vokes; Roger Bouillon Journal: J Clin Endocrinol Metab Date: 2016-03-04 Impact factor: 5.958
Authors: Marianne C Astor; Kristian Løvås; Aleksandra Debowska; Erik F Eriksen; Johan A Evang; Christian Fossum; Kristian J Fougner; Synnøve E Holte; Kari Lima; Ragnar B Moe; Anne Grethe Myhre; E Helen Kemp; Bjørn G Nedrebø; Johan Svartberg; Eystein S Husebye Journal: J Clin Endocrinol Metab Date: 2016-05-17 Impact factor: 5.958