Surgical Outcomes of Subtotal Parathyroidectomy for Renal Hyperparathyroidism

다국어 초록 (Multilingual Abstract)

Objectives. The aim of this study was to evaluate the effectiveness of subtotal parathyroidectomy for patients with renal hyperparathyroidism.
Methods. We studied 25 patients with renal hyperparathyroidism who underwent subtotal parathyroidectomy from October 2002 to October 2017. We analyzed serum intact parathyroid hormone (iPTH), calcium, and inorganic phosphorus levels before and at multiple time points following surgery, and evaluated the surgical outcomes and complications.
Results. Of the 25 patients, 13 (52%) were male and 12 (48%) were female, and the mean age was 53.4±9.3 years. The mean duration of dialysis before parathyroidectomy was 156.8±79.5 months. Mean preoperative serum iPTH and calcium levels were 1,199.0±571.3 pg/mL and 10.5±1.0 mg/dL, respectively. At 6 months postoperatively, the mean iPTH and calcium levels decreased to 49.2±47.6 pg/mL (P<0.01) and 8.0±1.0 mg/dL (P<0.01), respectively. Recurrent hyperparathyroidism occurred in two patients: one subsequently underwent kidney transplantation and the other continued hemodialysis and maintained normal calcium levels. One patient developed postoperative permanent hypoparathyroidism.
Conclusion. Subtotal parathyroidectomy is a safe and effective surgical treatment for renal hyperparathyroidism.

참고문헌 (Reference)

1 Liu ME, "To assess the effects of parathyroidectomy(TPTX versus TPTX+AT)for secondary hyperparathyroidism in chronic renal failure : a systematic review and meta-analysis" 44 : 353-362, 2017

2 Alkhalili E, "The utility of neck ultrasound and sestamibi scans in patients with secondary and tertiary hyperparathyroidism" 39 (39): 701-705, 2015

3 Madorin C, "The surgical management of renal hyperparathyroidism" 269 (269): 1565-1576, 2012

4 Lorenz K, "Surgical management of secondary hyperparathyroidism in chronic kidney disease : a consensus report of the European Society of Endocrine Surgeons" 400 (400): 907-927, 2015

5 Xu D, "Surgical management of secondary hyperparathyroidism : how to effectively reduce recurrence at the time of primary surgery" 39 (39): 509-514, 2016

6 Konturek A, "Subtotal parathyroidectomy for secondary renal hyperparathyroidism : a 20-year surgical outcome study" 401 (401): 965-974, 2016

7 Liang Y, "Short-term efficacy of surgical treatment of secondary hyperparathyroidism" 19 (19): 3904-3909, 2015

8 Saliba W, "Secondary hyperparathyroidism : pathophysiology and treatment" 22 (22): 574-581, 2009

9 Cunningham J, "Secondary hyperparathyroidism : pathogenesis, disease progression, and therapeutic options" 6 (6): 913-921, 2011

10 Jimenez Vibora E, "Renal hyperparathyroidism’s control after subtotal parathyroidectomy" 25 (25): 416-421, 2005

11 de Francisco AL, "Parathyroidectomy in dialysis patients" (Suppl 80) : 161-166, 2002

12 Sakman G, "Outcomes of total parathyroidectomy with autotransplantation versus subtotal parathyroidectomy with routine addition of thymectomy to both groups : single center experience of secondary hyperparathyroidism" 31 (31): 77-82, 2014

13 Rajeev P, "Outcomes of parathyroidectomy in renal hyperparathyroidism in patients with No access to renal transplantation in Singapore" 25 : 64-68, 2016

14 Dotzenrath C, "Operative treatment of renal autonomous hyperparathyroidism: cause of persistent or recurrent disease in 304 patients" 387 (387): 348-354, 2003

15 Tominaga Y, "More than 1,000 cases of total parathyroidectomy with forearm autograft for renal hyperparathyroidism" 38 (38): S168-S171, 2001

16 Stracke S, "Long-term outcome after total parathyroidectomy for the management of secondary hyperparathyroidism" 111 (111): c102-c109, 2009

17 National Kidney Foundation, "K/DOQI clinical practice guidelines for bone metabolism and disease in chronic kidney disease" 42 (42): S1-S201, 2003

18 Schneider R, "Initial parathyroid surgery in 606 patients with renal hyperparathyroidism" 36 (36): 318-326, 2012

19 Moe S, "Definition, evaluation, and classification of renal osteodystrophy : a position statement from Kidney Disease : Improving Global Outcomes(KDIGO)" 69 (69): 1945-1953, 2006

20 Bellorin-Font E, "Clinical practice guidelines for the prevention, diagnosis, evaluation and treatment of mineral and bone disorders in chronic kidney disease(CKD-MBD)in adults" 33 (33): 1-28, 2013

21 Guideline Working Group, Japanese Society for Dialysis Therapy, "Clinical practice guideline for the management of secondary hyperparathyroidism in chronic dialysis patients" 12 (12): 514-525, 2008

22 Lim CT, "Clinical course after parathyroidectomy in adults with end-stage renal disease on maintenance dialysis" 11 (11): 265-269, 2018

23 Wimmer G, "CT-MIBI-SPECT image fusion predicts multiglandular disease in hyperparathyroidism" 395 (395): 73-80, 2010