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Outcomes for minimally invasive parathyroidectomy: widening inclusion criteria based on preoperative imaging results
Author(s) -
Reilly Daniel J,
Chew Grace L.,
Eckhaus Jazmin,
Smoll Nicolas R.,
Farrell Stephen G.
Publication year - 2016
Publication title -
anz journal of surgery
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.426
H-Index - 70
eISSN - 1445-2197
pISSN - 1445-1433
DOI - 10.1111/ans.12885
Subject(s) - medicine , primary hyperparathyroidism , parathyroidectomy , ultrasound , gold standard (test) , radiology , parathyroid adenoma , retrospective cohort study , surgery , hyperparathyroidism , parathyroid hormone , calcium
Background Primary hyperparathyroidism is caused by a single adenoma in at least 80% of cases. Minimally invasive parathyroidectomy ( MIP ) has overtaken bilateral neck exploration as the gold standard for treatment in cases with adequate preoperative localization. There is evidence that, following careful review of preoperative imaging by the surgeon, increasing numbers of patients can successfully undergo MIP . Methods We conducted a retrospective review of 225 consecutive cases performed by a single surgeon. Outcomes for patients with disease reported as localized by radiologists and nuclear medicine physicians using sestamibi and ultrasound were compared with patients with negative or indeterminate localization studies, in which the surgeon reviewed the sestamibi, performed an ultrasound study and identified likely single adenomas and planned MIP . Results One hundred and sixty patients with radiologist‐localized disease and an additional 29 patients with surgeon‐localized disease underwent MIP . The surgeon‐localized group had higher rates of conversion to bilateral neck exploration (21% compared with 4%, P = 0.004), but rates of failure to cure were comparable between the two groups (4.3% compared with 2.8%). Conclusion Careful review of preoperative sestamibi and ultrasound studies by an experienced surgeon can increase the number of patients that can successfully undergo MIP for the treatment of primary hyperparathyroidism. Offering MIP to these patients does not result in increased rates of failure or recurrence.