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Meta-Analysis
. 2017 Nov;39(1):678-687.
doi: 10.1080/0886022X.2017.1363779.

Total parathyroidectomy versus total parathyroidectomy with autotransplantation for secondary hyperparathyroidism: systematic review and meta-analysis

Changjia Li  1 , Liang Lv  1 , Hongqiao Wang  2 , Xufu Wang  3 , Bangxu Yu  4 , Yan Xu  5 , Xiaobin Zhou  6 , Yanbing Zhou  1
Affiliations
Meta-Analysis

Total parathyroidectomy versus total parathyroidectomy with autotransplantation for secondary hyperparathyroidism: systematic review and meta-analysis

Changjia Li et al. Ren Fail. 2017 Nov.

Abstract

Background: Total parathyroidectomy (tPTX) and total parathyroidectomy with autotransplantation (tPTX + AT) are effective and inexpensive treatments for secondary hyperparathyroidism (sHPT), but we do not know which one is the optimal approach. Therefore, we undertook a meta-analysis to compare the safety and efficacy of these two surgical procedures.

Methodology: Studies published in English on PubMed, Embase and the Cochrane Library from inception to 27 September 2016 were searched systematically. Eligible studies comparing tPTX with tPTX + AT for sHPT were included and Review Manager v5.3 was used.

Results: Eleven studies were included in this meta-analysis. Ten cohort studies and one randomized controlled trial (RCT) involving 1108 patients with sHPT were identified. There was no significant difference in the prevalence of surgical complications (relative risk [RR], 1.71; 95% confidence interval [CI], 0.77-3.79; p = .19), all-cause mortality (RR, 0.68; 95% CI, 0.33-1.39; p = .29), sHPT persistence (RR, 3.81; 95% CI, 0.56-25.95; p = .17) or symptomatic improvement (RR, 1.02; 95% CI, 0.91-1.13; p = .79). tPTX could reduce the risk of sHPT recurrence (RR, 0.19; 95% CI, 0.09-0.41; p < .0001) and reoperation because of recurrence or persistence of sHPT (RR, 0.46; 95% CI 0.24-0.86; p = .01) compared with tPTX + AT. Simultaneously, tPTX increased the risk of hypoparathyroidism (RR, 2.63; 95% CI, 1.06-6.51; p = .04).

Conclusions: We found tPTX and tPTX + AT to be useful methods for sHPT treatment. tPTX was superior for reducing the risk of sHPT recurrence and reoperation than tPTX + AT but, due to a lack of high statistical-power RCTs, comparative studies will be needed in the future.

Keywords: Secondary hyperparathyroidism; chronic kidney disease; meta-analysis; parathyroidectomy.

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Figures

Figure 1.
Figure 1.
Flow diagram of the identification process for eligible studies.
Figure 2.
Figure 2.
Forest plot for surgical complications.
Figure 3.
Figure 3.
Forest plot for all-cause mortality.
Figure 4.
Figure 4.
Forest plot for reoperation because of persistence or recurrence of sHPT.
Figure 5.
Figure 5.
Forest plot for persistence of sHPT.
Figure 6.
Figure 6.
Forest plot for sHPT recurrence.
Figure 7.
Figure 7.
Forest plot for hypoparathyroidism.
Figure 8.
Figure 8.
Forest plot for symptomatic improvement.
Figure 9.
Figure 9.
Funnel plot for sHPT recurrence.
See this image and copyright information in PMC

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