Publication date: Available online 13 October 2018
Source: European Annals of Otorhinolaryngology, Head and Neck Diseases
Author(s): M. Veyrat, H. Fessi, J.-P. Haymann, P. Ronco, J. Lacau St Guily, S. Périé
Abstract
Objective
There is at present no consensus concerning surgical techniques for secondary hyperparathyroidism (SHPT) in end-stage renal disease (ESRD). Although both subtotal and total parathyroidectomy provide low rates of recurrence, they may induce hypoparathyroidism, damaging the bone and cardiovascular systems. The aim of our study was to compare 3/4 and 7/8 parathyroidectomy in this population and to discuss the potential benefit of more conservative treatment.
Study design
Prospective observational study in a university teaching hospital between 2010 and 2014.
Methods
The study included 34 consecutive ESRD patients with SHPT: 19 underwent 3/4 parathyroidectomy (group A*3/4) and 15 underwent 7/8 parathyroidectomy (group B*7/8). Serum intact 1-84 PTH levels (before and 6 months after surgery) and hospital stay were compared between the two groups.
Results
Before surgery, PTH levels were similar between the two groups. At month 6 following surgery, median PTH levels were significantly higher in group A*3/4 than in group B*7/8 (109 versus 24 pg/mL, respectively; P < 0.0006). Hospital stay was shorter in group A*3/4 (4.79 versus 6.80 days, respectively; P = 0.008). Postoperative hypoparathyroidism requiring long-term calcium and 1alpha(OH) D3 treatment was reported in 5% of patients in group A*3/4 and 26% of patients in group B*7/8 (P = 0.04).
Conclusions
In this preliminary study, 3/4 conservative parathyroidectomy seemed effective and safe, with less reported morbidity than 7/8 parathyroidectomy, as assessed by lower rates of irreversible hypoparathyroidism and shorter hospital stay.
Level of evidence
3b, individual case-control study.
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