Abstract
Purpose
The purpose of this study is to investigate the results of first-time surgery for sporadic primary hyperparathyroidism (pHPT) in patients with preoperatively negative sestamibi scintigraphy and ultrasound.
Methods
Data were gathered prospectively in a multicenter database for quality control in parathyroid surgery. Between 2004 and 2008, 3,158 patients underwent first-time surgery for sporadic pHPT. A total of 984 patients were subjected to preoperative localization with ultrasound and sestamibi scintigraphy, and in 173 patients, both investigations were negative. Intraoperative findings and early outcome are reported.
Results
One hundred and fifty-five of 173 patients underwent bilateral neck exploration. The median weight of excised parathyroid tissue was 350 mg. In 23 patients (13.3%), the exploration was negative. A total of 112 patients (64.7%) had a histological diagnosis of parathyroid adenoma and 38 patients (22%) had multiglandular disease. Six weeks after operation, 164 patients were available for analysis, and 30 patients (18%) had persistent pHPT. The risk for persistent pHPT increased for patients with few intraoperatively identified (p = 0.001) and excised (p = 0.024) parathyroid glands. Patients operated with intraoperative parathyroid hormone (iOPTH) had lower risk for persistent pHPT 7/79 (9%) compared with 23/85 patients (27%) operated without iOPTH (p = 0.003).
Conclusions
Negative localization with sestamibi and ultrasound in pHPT infers a highly selected patient population with small parathyroid adenomas, an alarmingly high rate of negative exploration, and an increased risk for persistent disease. The use of iOPTH influences cure rate favorably.
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Acknowledgement
This study was supported by grants from:
The European Union (Interreg. IIIA)
The Swedish Board of Health and Social Welfare
The Swedish Association of Local Authorities and Regions
The following departments participated in this study:
Department of Surgery, Lund University Hospital
Department of Breast and Endocrine Surgery, Copenhagen University Hospital Rigshospitalet
Department of Surgery, Central Hospital, Kristianstad
Department of Surgery, Helsingborg Hospital
Department of Surgery, University Hospital of Uppsala
Center for Metabolism and Endocrinology, Karolinska University Hospital-Huddinge
Department of Surgery, Central Hospital, Halmstad
Department of Surgery, Falu Hospital
Department of Surgery, Växjö Central Hospital
Department of Surgery, Västerås Central Hospital
Department of Surgery, Södersjukhuset
Department of Surgery, Karolinska University Hospital
Department of Surgery, Sunderby Hospital
Department of Surgery and Transplantation, Sahlgrenska University Hospital
Department of Surgery, Nyköping Hospital
Department of Surgery, University Hospital of Umeå
Center for Endocrine Neck Surgery, ENT Department F, Odense University Hospital
Department of Surgery, Norra Älvsborgs Länssjukhus
Department of Surgery, Jönköping Hospital Ryhov
Department of Surgery, Åhus University Hospital
Department of Surgery, Karlstad Central Hospital
Department of Surgery, Sundsvall Hospital
Department of Surgery, Kungälv Hospital
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All authors are members of the Steering Committee of the Scandinavian Quality Register for Thyroid and Parathyroid Surgery (www.thyroid-parathyroidsurgery.com).
Authors’ contribution
The study conception and design were made by Anders O. J. Bergenfelz, Göran Wallin, Svante Jansson, Håkan Eriksson, Hans Mårtensson, Peer Christiansen, and Eva Reihnér.
Acquisition of data was done by Anders O. J. Bergenfelz, Göran Wallin, Svante Jansson, Håkan Eriksson, Hans Mårtensson, Peer Christiansen, and Eva Reihnér.
Analysis and interpretation of data were made by Anders O. J. Bergenfelz.
Drafting of the manuscript was done by Anders O. J. Bergenfelz.
Critical revision of the manuscript was done by Anders O. J. Bergenfelz, Göran Wallin, Svante Jansson, Håkan Eriksson, Hans Mårtensson, Peer Christiansen, and Eva Reihnér.
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Bergenfelz, A.O.J., Wallin, G., Jansson, S. et al. Results of surgery for sporadic primary hyperparathyroidism in patients with preoperatively negative sestamibi scintigraphy and ultrasound. Langenbecks Arch Surg 396, 83–90 (2011). https://doi.org/10.1007/s00423-010-0724-0
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DOI: https://doi.org/10.1007/s00423-010-0724-0