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Parathyroid surgery in the elderly: should minimally invasive surgery be abandoned?
Michal Mekel1, Hayim Gilshtein, Katya Chapchay
1Department of General Surgery, Rambam-Health Care Campus, Haifa, Israel, m_mekel@rambam.health.gov.il.
Annals of Surgical Oncology
|December 6, 2013
Summary
Multiglandular disease (MGD) in primary hyperparathyroidism (PHPT) is more common in older adults. Surgeons should consider bilateral neck exploration in elderly patients, particularly if imaging suggests small parathyroid glands.
Area of Science:
- Endocrine Surgery
- Surgical Outcomes
- Geriatric Medicine
Background:
- Primary hyperparathyroidism (PHPT) is commonly caused by single adenomas, leading to widespread adoption of minimally invasive parathyroidectomy (MIP).
- The incidence of PHPT increases with age, yet data on multiglandular disease (MGD) prevalence in older populations is limited.
Purpose of the Study:
- To investigate the prevalence of MGD in older patients undergoing parathyroid surgery.
- To compare surgical outcomes and gland characteristics between younger and older patient groups.
Main Methods:
- Retrospective review of 537 patients undergoing parathyroid surgery across two centers.
- Comparison of patients younger than 65 years (YG) versus older than 65 years (OG).
- Analysis of clinical variables including preoperative data, extent of exploration, glands excised, and intraoperative parathyroid hormone levels.
Main Results:
- MGD was significantly more prevalent in the older group (24% vs. 12%, p=0.001).
- Minimally invasive parathyroidectomy was less frequently completed in older patients (49% vs. 68%, p<0.001).
- Cure rates were comparable between age groups (93% vs. 95%, p=0.27). In older patients with MGD, glands were significantly smaller than in those with single adenomas (331 ± 67 mg vs. 920 ± 97 mg, p=0.006).
Conclusions:
- Multiglandular disease is more prevalent in older patients with PHPT.
- Bilateral neck exploration should be considered for older patients, especially when imaging suggests small parathyroid glands or small glands are encountered during surgery.
