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[Sequential parathyroidectomy under cervical plexus anesthesia for secondary hyperparathyroidism with renal function

Y Hu1, S R Hua, M Y Wang

  • 1Department of General Surgery, Peking Union Medical College Hospital, Peking Union Medical College & Chinese Academy of Medical Sciences, Beijing 100730, China.

Zhonghua Wai Ke Za Zhi [Chinese Journal of Surgery]
|July 23, 2018
PubMed
Summary

Sequential parathyroidectomy is a viable surgical strategy for managing secondary hyperparathyroidism, particularly in patients with severe complications. This approach may reduce intensive care unit admissions compared to bilateral exploration.

Keywords:
Hyperparathyroidism, secondaryParathyroidectomyRenal insufficiency, chronic

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Area of Science:

  • Endocrinology
  • Surgical Oncology
  • Nephrology

Background:

  • Secondary hyperparathyroidism is a common complication in patients with chronic kidney disease.
  • Parathyroidectomy is a treatment option for severe secondary hyperparathyroidism.
  • The optimal surgical strategy for parathyroidectomy in this patient population is still under investigation.

Purpose of the Study:

  • To evaluate the efficacy and safety of sequential parathyroidectomy for secondary hyperparparathyroidism.
  • To compare sequential parathyroidectomy with bilateral neck exploration.

Main Methods:

  • A retrospective study comparing 32 patients with secondary hyperparathyroidism who underwent parathyroidectomy.
  • Patients were divided into two groups: bilateral neck exploration and sequential parathyroidectomy.
  • Sequential parathyroidectomy involved a unilateral exploration initially, with a second contralateral exploration if needed based on serum intact parathyroid hormone (iPTH) levels and symptoms.

Main Results:

  • In the sequential parathyroidectomy group, 11 out of 15 patients with elevated iPTH after the initial surgery underwent a second procedure, successfully lowering iPTH in 10 patients.
  • The bilateral exploration group required reoperation in 3 out of 5 patients with elevated iPTH.
  • Fewer patients in the sequential parathyroidectomy group required intensive care unit admission compared to the bilateral exploration group, though this difference was not statistically significant (P=0.063).

Conclusions:

  • Sequential parathyroidectomy is a feasible surgical strategy for secondary hyperparathyroidism, especially in cases with severe complications.
  • Further large-scale, prospective studies are necessary to definitively establish the effectiveness of this approach.