Image-directed parathyroidectomy under local anaesthesia in the elderly

Area of Science:

• Endocrinology
• Surgical Oncology
• Geriatric Medicine

Background:

• Elderly patients face higher surgical risks, necessitating specialized approaches.
• Primary hyperparathyroidism (HPT) can cause significant symptoms in older adults.
• Evaluating surgical outcomes in this demographic is crucial for optimizing care.

Purpose of the Study:

• To assess the effectiveness and safety of targeted parathyroid operations in patients over 70 years old.
• To determine the feasibility of focused surgical strategies for HPT in the elderly.
• To evaluate the impact of targeted parathyroidectomy on patient outcomes and recovery.

Main Methods:

• Prospective data collection and retrospective review of 40 patients over 70 undergoing targeted parathyroidectomy for HPT.
• Preoperative localization of parathyroid adenomas using ultrasonography and/or sestamibi scintigraphy.
• Surgical procedures performed, including neck exploration under local anesthesia with sedation for 33 patients.

Main Results:

• 39 of 40 patients achieved normalized intraoperative parathyroid hormone levels, predicting successful postoperative eucalcaemia.
• The majority of tumors were solitary adenomas (37/40), with two carcinomas identified.
• 29 patients were discharged same-day, and 19 of 21 reported symptom improvement.

Conclusions:

• Focused neck exploration is a safe and effective alternative to bilateral exploration for elderly patients with localized solitary parathyroid adenomas.
• Targeted parathyroidectomy under local anesthesia is recommended for most elderly patients with HPT.
• This approach offers improved patient outcomes and facilitates rapid recovery in the geriatric population.