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. 2012 Dec;152(6):1008-15.
doi: 10.1016/j.surg.2012.08.022. Epub 2012 Oct 12.

Is minimally invasive parathyroidectomy associated with greater recurrence compared to bilateral exploration? Analysis of more than 1,000 cases

David F Schneider  1 , Haggi Mazeh, Rebecca S Sippel, Herbert Chen
Affiliations

Is minimally invasive parathyroidectomy associated with greater recurrence compared to bilateral exploration? Analysis of more than 1,000 cases

David F Schneider et al. Surgery. 2012 Dec.

Abstract

Background: The durability of minimally invasive parathyroidectomy (MIP) has been questioned, and some advocate for routine open parathyroidectomy (OP). This study compared outcomes between patients treated with MIP compared with OP for primary hyperparathyroidism (PHPT).

Methods: A retrospective review was performed to identify cases of PHPT with single adenomas (SA) between 2001 and 2011. Operations were classified as OP when both sides were explored. Kaplan-Meier estimates were plotted and compared by the log-rank test.

Results: We analyzed 1,083 patients with PHPT with SA; 928 (85.7%) were MIP and 155 (14.3%) were OP. There was no difference in the rates of persistence (0.2% MIP vs 0% OP, P = .61) or recurrence (2.5% MIP vs 1.9% OP, P = .68) between the 2 groups. The Kaplan-Meier estimates did, however, began to separate beyond 8 years' follow-up. The OP group did experience a greater incidence of transient hypocalcemia postoperatively (1.9% vs 0.1%, P = .01).

Conclusion: MIP appears equivalent to OP in single-gland disease. Although patients undergoing OP experienced more transient hypocalcemia, patients undergoing MIP appear to have a greater long-term recurrence rate. Therefore, proper patient selection and counseling of these risks is necessary for either approach.

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Figures

Figure 1
Figure 1. Recurrence
Kaplan-Meier plots for recurrent hyperparathyroidism. These plots were compared by the log-rank test with the p value indicated. OPEN = open parathyroidectomy, MIP = minimally invasive parathyroidectomy.
See this image and copyright information in PMC

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