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. 2017 Jan;161(1):54-61.
doi: 10.1016/j.surg.2016.05.049. Epub 2016 Nov 15.

How long should we follow patients after apparently curative parathyroidectomy?

Irene Lou  1 , Courtney Balentine  2 , Samuel Clarkson  1 , David F Schneider  1 , Rebecca S Sippel  1 , Herbert Chen  3
Affiliations

How long should we follow patients after apparently curative parathyroidectomy?

Irene Lou et al. Surgery. 2017 Jan.

Abstract

Background: Little is known about the long-term recurrence risk for primary hyperparathyroidism after immediately "curative" parathyroidectomy. This study aimed to evaluate the risk of recurrent hyperparathyroidism in the 10 years after operation.

Method: We retrospectively identified patients with sporadic primary hyperparathyroidism undergoing initial parathyroidectomy between November 1, 2000 and June 30, 2005. Recurrence was defined as serum calcium >10.2 mg/dL after 6 months from operation. Kaplan-Meier estimates and Cox proportional hazards were used to evaluate disease-free survival and predictors of recurrence.

Results: We evaluated 196 patients with a 14.8% 10-year recurrence rate. Median time to recurrence was 6.3 years (interquartile range 3.4-10.8 years), and 34.5% of all recurrences were identified >10 years after operation. There was no difference in recurrence between open and minimally invasive operation (P = .448). Double adenomas (P = .006), intraoperative parathyroid hormone drop <70% (P = .015), and young age (P = .032) were predictive of disease recurrence. Multivariable analysis demonstrated that older age was protective against recurrence (hazard ratio 0.97, 95% confidence interval 0.94-0.99, P = .034), while double adenomas (hazard ratio 3.52, 95% confidence interval 1.23-10.08, P = .019) were an independent predictor for recurrence.

Conclusion: The long-term recurrence rate for sporadic primary hyperparathyroidism after "curative" parathyroidectomy is likely greater than reported. With over one-third of our institutional recurrences at >10 years after the initial operation, long-term follow-up is essential.

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Figures

Figure 1
Figure 1. Patient selection
2HPT=secondary hyperparathyroidism, 3HPT=tertiary hyperparathyroidism, MEN=multiple endocrine neoplasia, HPT=hyperparathyroidism, 1HPT=primary hyperparathyroidism *Recurrence defined as hypercalcemia at >6months after parathyroid surgery
Figure 2
Figure 2
Kaplan-Meier Recurrence Free Survival Curves A. By parathyroid operation performed with reference line at 5 years and 10 years, number at risk for various time points shown below B. By disease etiology
Figure 2
Figure 2
Kaplan-Meier Recurrence Free Survival Curves A. By parathyroid operation performed with reference line at 5 years and 10 years, number at risk for various time points shown below B. By disease etiology
Figure 3
Figure 3
Recurrence-Free Survival Stratified by Age A. With Single Adenoma B. With Intraoperative PTH drop > 70%
Figure 3
Figure 3
Recurrence-Free Survival Stratified by Age A. With Single Adenoma B. With Intraoperative PTH drop > 70%
See this image and copyright information in PMC

Comment in

  • Discussion.
    [No authors listed] [No authors listed] Surgery. 2017 Jan;161(1):60-61. doi: 10.1016/j.surg.2016.05.053. Epub 2016 Nov 15. Surgery. 2017. PMID: 27863785 No abstract available.

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