Efficacy of selective unilateral exploration in hyperparathyroidism based on localization tests

Area of Science:

• Endocrinology
• Surgical Oncology
• Diagnostic Imaging

Background:

• Primary hyperparathyroidism is a common endocrine disorder often requiring surgical intervention.
• Preoperative localization of parathyroid adenomas is crucial for guiding surgical strategy.
• The choice between unilateral and bilateral exploration impacts operative time and outcomes.

Purpose of the Study:

• To compare the success rates of unilateral versus bilateral surgical exploration for primary hyperparathyroidism.
• To evaluate the diagnostic accuracy of preoperative localization tests, including ultrasound and thallium-technetium scintigraphy.
• To determine the optimal surgical approach based on localization test validity.

Main Methods:

• A case-control study involving 100 consecutive patients undergoing parathyroidectomy for primary hyperparathyroidism.
• Patients underwent preoperative neck ultrasonography and thallium-technetium scintigraphy.
• Surgical exploration was performed either unilaterally (n=43) or bilaterally (n=57) by a single surgeon.

Main Results:

• Localization tests identified solitary adenomas in 87% of cases, with combined accuracy of 73% for ultrasonography and scintigraphy.
• Unilateral exploration successfully identified all single adenomas (43/43), while bilateral exploration identified 51 single adenomas and 6 cases of multiple-gland disease.
• Unilateral exploration averaged 105 minutes, significantly shorter than bilateral exploration at 184 minutes (P < .001).
• Postoperative hypercalcemia rates were similar between the two groups.

Conclusions:

• Unilateral exploration, when guided by accurate preoperative localization, is a safe and effective approach for primary hyperparathyroidism.
• This strategy leads to comparable surgical success rates as bilateral exploration.
• Unilateral exploration significantly reduces operative time, enhancing surgical efficiency.