Long term results of total parathyroidectomy/autotransplantation without cryopreservation in secondary hyperparathyroidism
Abstract
Purpose: The aim of this study was to compare the efficacy and early-late results of subtotal parathyroidectomy and total parathyroidectomy/auto transplantation without cryopreservation conducted on cases with secondary hyperparathyroidism (HPT).
Materials and Methods: 68 patients with secondary HPT who had parathyroidectomy were analysed retrospectively. In group1 (n=47) subtotal parathyroidectomy, in group2 (n=21) total parathyroidectomy/auto transplantation without cryopreservation were performed in our clinic. Patients' demographic characteristics and clinical features were evaluated.
Results: In group1 8 patients (14.9%), in group2 17 patients (76.2%) had concurrent thymectomies. The rates of persistant HPT in group1 and group2 were 14.9% (n=7), 4.8% (n=1) respectively. In group2 no recurrent HPT was seen, in group2 10.6% (n=5) of the patients had recurrent HPT. The reasons of persistent and recurrent HPT were ectopic or supernumerary glands in 69.2% (n=9) of the patients.
Conclusion: In patients with end stage renal failure and secondary HPT, bilateral cervical thymectomy concurrent with total parathyroidectomy/auto transplantation without cryopreservation can be applied as a safe and efficient surgical procedure.
Keywords
Hyperparathyroidism,secondary,parathyroidectomy,autotransplantation,thymectomy
Kaynakça
- 1. Walker MD, Silverberg SJ.Primary hyperparathyroidism. Nat Rev Endocrinol. 2018 Feb;14(2):115-125.
- 2. Hörl WH. The clinical consequences of secondary hyperparathyroidism: Focus on clinical outcomes. Nephrol. Dial. Transplant (2004);19 [Suppl 5]: v2–v8.
- 3. Bellorin-Font E, Ambrosoni P, Carlini RG et al. Clinical practice guidelines for the prevention, diagnosis, evaluation and treatment of mineral and bone disorders in chronic kidney disease (CKD-MBD) in adults. Nefrologia 2013; 33: 1–28.
- 4. Palmer SC, Nistor I, Craig JC et al. Cinacalcet in patients with chronic kidney disease: A cumulative meta-analysis of randomized controlled trials. PLoS Med. 2013; 10 e1001436.
- 5. Neagoe RM, Muresan M, Voidazan S, et al. Subtotal parathyroidectomy versus total parathyroidectomy with autotransplant in secondary hyperparathyroidism: a single-centre prospective cohort of 43 patients. Endokrynol Pol 2016;67:202–9.
- 6. Komaba H, Taniguchi M, Wada A, Iseki K, Tsubakihara Y, Fukagawa M. Parathyroidectomy and survival among Japanese hemodialysis patients with secondary hyperparathyroidism. Kidney Int. 2015; 88: 350–9.
- 7. F. Albuquerque RFC, Carbonara CEM, Martin RCT, Dos Reis LM, do Nascimento CP Júnior, Arap SS, Moysés RMA, Jorgetti V, Montenegro FLM, de Oliveira RB. Parathyroidectomy in patients with chronic kidney disease: Impacts of different techniques on the biochemical and clinical evolution of secondary hyperparathyroidism. Surgery. 2018 Feb;163(2):381-387.
- 8. Albright F, Bauer W, Ropes M, Aub JC. Studies of calcium and phosphorus metabolism: IV. The Effect of the Parathyroid Hormone. J Clin Invest. 1929 Apr;7(1):139-81.
- 9. Ivarsson KM, Akaberi S, Isaksson E, et al. The effect of parathyroidectomy on patient survival in secondary hyperparathyroidism. Nephrol Dial Transplant 2015;30:2027–33.
- 10. Decker PA, Cohen EP, Doffek KM, Ashley BA, Bienemann ME, Zhu YR, et al. Subtotal parathyroidectomy in renal failure: still needed after all these years. World J Surg 25:708-12, 2001.
