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Scan-directed unilateral neck exploration for primary hyperparathyroidism: eight-year results from a regional
S W Wong1, K W Chan, N M Paulose
1Department of Surgery, North District Hospital, Sheung Shui, Hong Kong. jeffwong@surgery.cuhk.edu.hk
Objective:
To determine the results of scan-directed unilateral neck exploration for primary hyperparathyroidism.
Design:
Retrospective study.
Setting:
Regional hospital, Hong Kong.
Patients:
Patients who underwent parathyroid surgery for primary hyperparathyroidism between January 2000 and December 2007 were included.
Main Outcome Measures:
The demographic, imaging, biochemical, and pathological data, as well as surgical outcomes were analysed according to the treatment received.
Results:
A total of 78 patients were included in this study; 65 underwent unilateral neck exploration with image guidance by ultrasonography or technetium Tc99m sestamibi scan. The scan sensitivity for localising the side of the lesion was 66% for ultrasound scans, 71% for technetium Tc99m sestamibi scans, and 85% for both scans used in combination. Pathological analysis showed that 95% (74/78) of the patients had a single parathyroid adenoma, two had hyperplasia of four glands, one had a double adenoma, and one a parathyroid carcinoma. Among the patients undergoing scan-directed unilateral neck exploration, one defaulted follow-up, while the remaining 64 patients achieved normal calcium levels at a median follow-up of 6 months.
Conclusion:
Scan-directed unilateral neck exploration is a safe alternative form of treatment for patients with primary hyperparathyroidism, with a cure rate similar to conventional therapy.
