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Objective To compare the clinical outcomes between microwave ablation (MWA) and parathyroidectomy (PTX) for the treatment of primary hyperparathyroidism (pHPT). Materials and methods This retrospective study enrolled 212 patients with pHPT treated by either MWA (MWA group) or PTX (PTX group) from January 2015 to October 2020. The baseline data were balanced through propensity score matching. Clinical cure was evaluated by the Kaplan-Meier method and compared between the MWA and PTX groups. The risk factors related to persistent or recurrent pHPT were screening out using a Cox proportional hazards regression model. Results After propensity score matching, a total of 174 patients were enrolled in the present study, with 87 patients in each group. During the follow-up period (median, 28.5 months), there were no differences between the two groups regarding the clinical cure (hazard ratio, 1.71; 95% confidence interval: 0.81-3.62;  p  = .155), persistent pHPT rate (13.8% vs. 10.3%,  p  = .643), recurrent pHPT rate (6.9% vs. 3.4%,  p  = .496), or major complications (6.9% vs. 3.4%,  p  = .496). MWA resulted in a shorter procedure time (30 min vs. 60 min), smaller incision length (0.1 cm vs. 7 cm) and slightly higher costs (25745 CNY vs. 24111 CNY) (all  p  &lt; .001). High levels of preoperative intact parathyroid hormone ( p  = .01) and multiple pHPT nodules ( p  &lt; .001) were independent risk factors for recurrent and persistent pHPT in the two groups. Conclusion MWA and PTX have comparable clinical outcomes for pHPT. MWA has a shorter procedure time and smaller incision length. Key Points • There were no differences in terms of clinical cure, persistent pHPT, recurrent pHPT, or major complications between MWA and PTX in the treatment of pHPT.  • MWA is minimally invasive and results in a shorter procedure time.  • Multiple nodules and high levels of iPTH were the independent risk factors for recurrent and persistent pHPT.

Microwave ablation versus parathyroidectomy for the treatment of primary hyperparathyroidism: a cohort study