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Outcomes of Subtotal Parathyroidectomy Versus Total Parathyroidectomy With Autotransplantation for Tertiary Hyperparathyroidism: Multi-institutional Study

Authors
 Hye Ryeon Choi  ;  Mohamed A Aboueisha  ;  Abdallah S Attia  ;  Mahmoud Omar  ;  Ahmad ELnahla  ;  Eman A Toraih  ;  Mohamed Shama  ;  Woong Youn Chung  ;  Jong Ju Jeong  ;  Emad Kandil 
Citation
 ANNALS OF SURGERY, Vol.274(4) : 674-679, 2021-10 
Journal Title
ANNALS OF SURGERY
ISSN
 0003-4932 
Issue Date
2021-10
MeSH
Adult ; Female ; Humans ; Hyperparathyroidism / complications ; Hyperparathyroidism / surgery* ; Hypoparathyroidism / prevention & control ; Kidney Transplantation ; Male ; Middle Aged ; Parathyroidectomy* ; Renal Dialysis ; Renal Insufficiency / complications ; Renal Insufficiency / therapy ; Retrospective Studies ; Transplantation, Autologous
Abstract
Objectives: Due to the paucity of data and controversy regarding the preferred surgical approach for managing tertiary HPT, we sought to investigate the outcomes of different surgical approaches in managing this challenging disease.

Methods: We performed a multi-center retrospective study to include patients with tertiary HPT who underwent STPX or total parathyroidectomy with autotransplantation (TPX-A).

Results: One hundred five patients had kidney transplant, and 43 were on dialysis. In the kidney transplant group, 61 patients underwent STPX, and 44 for TPX-A. Patients' demographics were not significantly different (48.61 ± 9.31 vs 47.95 ± 12.73 years, P = 0.759. The postoperative follow-up showed that the TPX-A cohort had a higher rate of hypoparathyroidism (N = 20, 45.45%) versus (N = 14, 22.95%) with the STPX cohort (P = 0.013). The cure among the TPX-A cohorts (84.09%) over the STPX cohort (73.77%) (P = 0.153). The long-term follow-up showed that the rate of developing temporary (N = 16, 41.03%) or permanent (N = 8, 20.51%) hypoparathyroidism was significantly higher among patients who underwent TPX-A over the patients who underwent STPX (N = 7, 17.95%), and (N = 4, 10.26%), respectively (P = 0.012). There was no statistical difference between the persistence (N = 3, 7.69%) or the recurrence (N = 2, 5.13%) of the HPT in the TPX-A cohort and the STPX cohort (N = 2, 5.13%). (N = 4, 10.26%), respectively, P = 0.644.

Conclusions: To our knowledge, this is the largest multi-center study that compared different approaches for managing tertiary HPT. Showing that STPX is the better modality in patients diagnosed with tertiary HPT and had kidney transplants avoiding the risk of hypoparathyroidism.
Full Text
https://journals.lww.com/annalsofsurgery/Fulltext/2021/10000/Outcomes_of_Subtotal_Parathyroidectomy_Versus.17.aspx
DOI
10.1097/SLA.0000000000005059
Appears in Collections:
1. College of Medicine (의과대학) > Dept. of Surgery (외과학교실) > 1. Journal Papers
Yonsei Authors
Chung, Woong Youn(정웅윤)
Jeong, Jong Ju(정종주) ORCID logo https://orcid.org/0000-0002-4155-6035
URI
https://ir.ymlib.yonsei.ac.kr/handle/22282913/187153
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