Parathyroidectomy Outcomes in Patients with Primary Hyperparathyroidism: Impact of Patient Factors, Preoperative Localization, and Surgical Characteristics

Öz

OBJECTIVE: A better understanding of the factors that may affect surgical success in primary hyperparathyroidism (PHPT) may prevent reoperations, which are known to be associated with more adverse outcomes. This study focuses on identifying the factors influencing surgical success in PHPT, with particular attention to preoperative localization techniques. MATERIAL and METHODS: We included 191 patients who underwent parathyroidectomy (PTx) for PHPT. Demographic, clinical and laboratory data, surgical characteristics, and preoperative localization findings were obtained. Comparisons were made by dividing patients into two groups, successful PTx or failed PTx, according to surgical outcomes. In addition, the correlation between preoperative localization findings and intraoperative findings in the successful PTx group was also evaluated. RESULTS: In our study (with a surgical success rate of 84.29% and a minimally invasive PTx [MIP] rate of 75.39%), parathyroid adenoma (PA) detection on ultrasonography had the highest sensitivity (92.55%) and low serum creatinine (<0.65mg/dL) had the highest specificity (93.33%) in predicting successful PTx. In multivariate analysis, MIP (p<0.001) and low serum creatinine (p=0.008) emerged as independent predictors of successful PTx, whereas diabetes mellitus (p=0.023) was identified as a predictor of failed PTx. We also found that ultrasonography was more concordant with intraoperative findings than was scintigraphy in both exact (65.84% vs. 57.76%) and side-only (80.12% vs. 72.67%) localization. CONCLUSION: Younger age, PA detection on ultrasonography, MIP, and absence of comorbidities (especially diabetes mellitus) may increase the surgical success rate in PHPT. We also think that ultrasonography is superior to scintigraphy for preoperative localization in PHPT. In this context, prospective studies with larger sample sizes are needed.

Anahtar Kelimeler

• Primary hyperparathyroidism
• parathyroidectomy
• surgical success
• preoperative localization

Etik Beyan

The Ethics Committee of the Necmettin Erbakan University (NEU) Medical Faculty approved the study (decision no: 2024/5200 and date: 20.09.2024).

Primer Hiperparatiroidili Hastalarda Paratiroidektomi Sonuçları: Hasta İlişkili Faktörler, Preoperatif Lokalizasyon ve Cerrahi Özelliklerin Etkisi

Öz

AMAÇ: Primer hiperparatiroidizmde (PHPT) cerrahi başarısını etkileyebilecek faktörlerin daha iyi anlaşılması, olumsuz sonuçlarla ilişkilendirilen reoperasyonların önlenmesine katkı sağlayabilir. Bu çalışma, PHPT’de cerrahi başarıyı etkileyen faktörleri belirlemeye odaklanmakta olup, özellikle preoperatif lokalizasyon yöntemlerine vurgu yapmaktadır. GEREÇ VE YÖNTEM: PHPT nedeniyle paratiroidektomi (PTx) uygulanan 191 hasta çalışmaya dahil edildi. Demografik, klinik ve laboratuvar verileri ile cerrahi özellikler ve preoperatif lokalizasyon bulguları kaydedildi. Hastalar cerrahi sonuçlarına göre “başarılı PTx” ve “başarısız PTx” olmak üzere iki gruba ayrılarak karşılaştırmalar yapıldı. Ayrıca başarılı PTx grubunda preoperatif lokalizasyon bulguları ile intraoperatif bulgular arasındaki uyum da değerlendirildi. BULGULAR: Çalışmamızda cerrahi başarı oranı %84,29 ve minimal invaziv PTx (MIP) oranı %75,39 olarak saptandı. Ultrasonografide paratiroid adenomunun (PA) saptanması, başarılı PTx’i öngörmede en yüksek duyarlılığa (%92,55), düşük serum kreatinin düzeyi (<0,65 mg/dL) ise en yüksek özgüllüğe (%93,33) sahipti. Çok değişkenli analizde MIP (p<0,001) ve düşük serum kreatinin düzeyi (p=0,008), başarılı PTx’in bağımsız belirleyicileri olarak belirlendi; diyabetes mellitus (p=0,023) ise başarısız PTx için bir öngördürücü olarak saptandı. Ayrıca ultrasonografinin hem kesin (65,84% vs. 57,76%) hem de taraf bazlı (80,12% vs. 72,67%) lokalizasyonda sintigrafiye göre intraoperatif bulgularla daha yüksek uyum gösterdiği bulundu. SONUÇ: Daha genç yaş, ultrasonografide PA saptanması, MIP uygulanması ve komorbidite olmaması (özellikle diyabetes mellitusun bulunmaması), PHPT’de cerrahi başarı oranını artırabilir. Ayrıca, PHPT’de preoperatif lokalizasyonda ultrasonografinin sintigrafiye göre daha üstün olduğunu düşünmekteyiz. Bu bağlamda, daha geniş örneklemli prospektif çalışmalara ihtiyaç vardır.

Anahtar Kelimeler

• Primer hiperparatiroidizm
• paratiroidektomi
• cerrahi başarı
• preoperatif lokalizasyon

Kaynakça

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