Risk factors for surgical failure in patients undergoing surgery for primary hyperparathyroidism.

Area of Science:

• Endocrinology
• Surgical Oncology
• Neurosurgery

Background:

• Primary hyperparathyroidism (PHPT) is a common endocrine disorder.
• Parathyroidectomy is the definitive treatment for PHPT.
• Understanding long-term outcomes and persistence risk factors is crucial.

Purpose of the Study:

• To evaluate long-term outcomes after parathyroidectomy for PHPT.
• To identify risk factors associated with persistence of PHPT post-surgery.

Main Methods:

• Retrospective study of 212 patients undergoing parathyroidectomy (2009-2019).
• Cure defined as normal calcium homeostasis for ≥6 months.
• Persistence defined as hypercalcemia >6 months post-surgery.
• Multivariate analysis used to identify independent risk factors for persistence.

Main Results:

• High cure rate (96.2%); low persistence (3.8%) and recurrence (1.4%) rates.
• Persistence independently associated with parathyroid hyperplasia (OR=12.6) and normal parathyroid tissue (OR=188) on histopathology.
• Four patients (1.9%) had normocalcemia with persistently elevated PTH.

Conclusions:

• Parathyroidectomy is a safe procedure with favorable long-term outcomes for PHPT.
• Histopathological findings of hyperplasia and normal parathyroid tissue are significant risk factors for persistence.
• An interdisciplinary approach is essential for preventing PHPT persistence.