Subtotal Parathyroidectomy vs Total Parathyroidectomy with Autotransplantation for Secondary Hyperparathyroidism in Dialysis Patients: Short- and Long-Term Outcomes - 23/05/19

Doi : 10.1016/j.jamcollsurg.2019.01.019

Polina V. Zmijewski, MD, MA ^a,^⁎ , Jonathan A. Staloff, BA ^b, Madeline J. Wozniak, BS ^b, Peter J. Mazzaglia, MD, FACS ^a
^a Department of Surgery, Rhode Island Hospital, Providence, RI
^b Alpert School of Medicine, Providence, RI

^∗Correspondence address: Polina V Zmijewski, MD, MA, Department of Surgery, Rhode Island Hospital, 593 Eddy St, APC 4, Providence, RI 02903.Department of SurgeryRhode Island Hospital593 Eddy St, APC 4ProvidenceRI02903

Abstract

Background

Two operations are performed for management of secondary hyperparathyroidism, subtotal parathyroidectomy (SPTX) and total parathyroidectomy with autotransplantation (TPTX-AT). There is no consensus among endocrine surgeons about which operation is the preferred treatment. This study compares the short- and long-term outcomes of SPTX and TPTX-AT for dialysis patients with secondary hyperparathyroidism.

Study Design

This is a retrospective review of 46 dialysis patients undergoing PTX from 2006 to 2017 at a 719-bed tertiary care hospital.

Results

Calcium on postoperative day 1 was 7.7 ± 0.8 mg/dL for SPTX and 7.9 ± 1.3 mg/dL for TPTX-AT (p = 0.49). Parathyroid hormone values on postoperative day 1 were 32.6 ± 26.0 pg/mL for SPTX and 9.5 ± 4.2 pg/mL for TPTX-AT (p ≤ 0.05). Hospital length of stay was 3.7 ± 1.9 days for SPTX and 4.4 ± 3.5 days for TPTX-AT (p = 0.46). The required doses of calcium and calcitriol at discharge did not differ significantly. Reoperation for recurrence or persistence of disease was required in 6 SPTX patients and 2 TPTX-AT patients (p = 0.12). Parathyroid hormone values <15 pg/mL at long-term follow-up occurred in 5.6% of SPTX patients and 26.7% of TPTX-AT patients (p = 0.09). Parathyroid hormone values >200 pg/mL at long-term follow-up occurred in 38.9% of SPTX patients vs 6.7% of the TPTX-AT patients (p ≤ 0.05). Calcium supplementation at more than 6 months was required for 36.8% of SPTX and 71.4% of TPTX-AT patients (p < 0.05).

Conclusions

The long-term control of parathyroid hormone elevation and avoidance of recurrent disease is improved with TPTX-AT, but carries a higher risk of long-term hypocalcemia.

Le texte complet de cet article est disponible en PDF.

Abbreviations and Acronyms : IOPTH, POD, PTH, SPTX, TPTX-AT

Plan

	CME questions for this article available at jacscme.facs.org
	Disclosure Information: Authors have nothing to disclose. Timothy J Eberlein, Editor-in-Chief, has nothing to disclose.