Surgical aspects of primary hyperparathyroidism

Perrier, Nancy; Lang, Brian H.; Farias, Leonardo Costa Bandeira; Poch, Leyre Lorente; Sywak, Mark; Almquist, Martin; Vriens, Menno R.; Yeh, Michael W.; Shariq, Omair; Duh, Quan-Yang; Yeh, Randy; Vu, Thinh; LiVolsi, Virginia; Sitges-Serra, Antonio

Affiliations

¹Department of Surgical Oncology, Section of Surgical Endocrinology, University of Texas M D Anderson Cancer Center, Houston, TX, USA

²Department of Surgery, Queen Mary Hospital, Pokfulam, Hong Kong

³Division of Endocrinology, Universidade Federal de Sao Paulo, Sao Paulo, Brazil

⁴Endocrine Surgery Unit, Universitat Autònoma de Barcelona, Barcelona, Spain

⁵Endocrine Surgery Unit, University of Sydney, Sydney, Australia

⁶Department of Surgery, Skåne University Hospital, Lund University, Lund, Sweden

⁷Department of Surgical Oncology and Endocrine Surgery, University Medical Center, Utrecht, The Netherlands

⁸Department of Surgery, Section of Endocrine Surgery, UCLA David Geffen School of Medicine, Los Angeles, CA, USA

⁹Oxford Centre for Diabetes, Endocrinology and Metabolism, Churchill Hospital, University of Oxford, Headington, UK

¹⁰Department of Surgery, University of California, San Francisco, CA, USA

¹¹Memorial Sloan Kettering Cancer Center, Molecular Imaging and Therapy Service, New York, NY, USA

¹²Neuroradiology Department, University of Texas MD Anderson Cancer Center, Houston, TX, USA

¹³Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA_

Abstract and keywords

Parathyroidectomy (PTX) is the treatment of choice for symptomatic primary hyperparathyroidism (PHPT). It is also the treatment of choice in asymptomatic PHPT with evidence for target organ involvement. This review updates surgical aspects of PHPT and proposes the following definitions based on international expert consensus: selective PTX (and reasons for conversion to an extended procedure), bilateral neck exploration for non-localized or multigland disease, subtotal PTX, total PTX with immediate or delayed autotransplantation, and transcervical thymectomy and extended en bloc PTX for parathyroid carcinoma. The systematic literature reviews discussed covered (i) the use of intraoperative PTH (ioPTH) for localized single-gland disease and (ii) the management of low BMD after PTX. Updates based on prospective observational studies are presented concerning PTX for multigland disease and hereditary PHPT syndromes, histopathology, intraoperative adjuncts, localization techniques, perioperative management, “reoperative” surgery and volume/outcome data. Postoperative complications are few and uncommon (<3%) in centers performing over 40 PTXs per year. This review is the first global consensus about surgery in PHPT and reflects the current practice in leading endocrine surgery units worldwide.

Keywords: PTH/VITAMIN D; PARATHYROID-RELATED DISORDERS; THERAPEUTICS-OTHER

Links

DOI: 10.1002/jbmr.4689

PubMed: 36054175

WoS: 000868495900001

History

Received: 2022-02-14

Revised: 2022-08-18

Accepted: 2022-08-24

Cited Works (2)

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Cited By (3)

Year	Entry
2022	Bilezikian JP, Khan AA, Clarke BL, Mannstadt M, Potts JT, Brandi ML. The Fifth International Workshop on the Evaluation and Management of Primary Hyperparathyroidism. J Bone Miner Res. November 2022;37(11):2290-2292.
2022	Bilezikian JP, Khan AA, Silverberg SJ, Fuleihan GE-H, Marcocci C, Minisola S, Perrier N, Sitges-Serra A, Thakker RV, Guyatt G, Mannstadt M, Potts JT, Clarke BL, Brandi ML; International Workshop on Primary Hyperparathyroidism. Evaluation and management of primary hyperparathyroidism: summary statement and guidelines from the Fifth International Workshop. J Bone Miner Res. November 2022;37(11):2293-2314.
2022	Ye Z, Silverberg SJ, Sreekanta A, Tong K, Wang Y, Chang Y, Zhang M, Guyatt G, Tangamornsuksun W, Zhang Y, Manja V, Bakaa L, Couban RJ, Brandi ML, Clarke B, Khan AA, Mannstadt M, Bilezikian JP. The efficacy and safety of medical and surgical therapy in patients with primary hyperparathyroidism: a systematic review and meta-analysis of randomized controlled trials. J Bone Miner Res. November 2022;37(11):2351-2372.