Med Bull Sisli Etfal Hosp. 2021; 55(2): 173-178 | DOI: 10.14744/SEMB.2021.72681

Parathyroidectomy Results in Primary Hyperparathyroidism: Analysis of the Results From a Single Center

Mehmet Taner Unlu¹, Nurcihan Aygun², Ismail Ethem Akgun², Gurkan Yetkin², Rumeysa Selvinaz Erol³, Adnan Isgor⁴, Mehmet Uludag^2
1Department of General Surgery, Basaksehir Cam and Sakura City Hospital, Istanbul, Turkey
²Department of General Surgery, University of Health Sciences Turkey, Sisli Hamidiye Etfal Teaching and Research Hospital, Istanbul, Turkey
³Division of Endocrinology and Metabolism, Department of Internal Medicine, University of Health Sciences Turkey, Sisli Hamidiye Etfal Teaching and Research Hospital, Istanbul, Turke
⁴Department of General Surgery, Bahcesehir University Faculty of Medicine, Istanbul, Turkey

Objectives: The curative treatment of primary hyperparathyroidism (PHPT) is surgery. Persistent and recurrent disease may develop after surgical treatment. In this study, we aimed to evaluate the surgical cure rate in patients who underwent surgery for PHPT in our clinic.
Methods: The data of patients who underwent parathyroidectomy for PHPT by two experienced surgeons between 2000 and 2015 in our clinic were retrospectively evaluated. Patients who were followed for at least 6 months after their first parathyroidectomy were included in the study. Surgical cure and persistent and recurrent disease rates were evaluated in patients.
Results: During this period, 368 interventions were performed in 357 patients (293 F and 64 M) who were operated for PHPT in our clinic, with a mean age of 54.9±13.1 years. In the first surgery, 116 patients (32.5%) had bilateral neck exploration, 251 patients (67.5%) had unilateral neck exploration (UNE) or focused parathyroid surgery (FPS). In the first operation, 343 patients (96.1%) had cure, 14 patients (13 F and 1 M) remained persistent. Secondary surgical intervention was performed in 11 patients. UNE or FPS was performed to 10 patients (90.9%); partial sternotomy was performed to one patient. Ten of the patients had cure. Three of these patients had a solitary parathyroid adenoma that was not removed in the first surgery, and seven patients had a second adenoma. Four patients remained persistent (1.1%). Recurrent disease developed in four patients during follow-up (1.1%). Total cure rate was 97.8%.
Conclusion: The only definitive treatment for PHPT is surgery. High surgical cure can be achieved by pre-operative evaluation and appropriate surgical planning. However, persistent PHPT may develop, especially due to double adenoma or ectopic location. Patients with persistent PHPT can be evaluated with repeat imaging methods and with appropriate surgical planning, a high cure rate can be obtained in secondary surgery, which can increase the total surgical cure rate. Recurrence rate is rare.

Keywords: Hyperparathyroidism, parathyroidectomy; persistent disease; recurrent disease.

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Primer hiperparatiroidide paratiroidektomi sonuçlarý: Tek merkez sonuçlarýnýn analizi

Mehmet Taner Unlu¹, Nurcihan Aygun², Ismail Ethem Akgun², Gurkan Yetkin², Rumeysa Selvinaz Erol³, Adnan Isgor⁴, Mehmet Uludag^2
1Baþakþehir Cam ve Sakura Þehir Hastanesi, Genel Cerrahi Kliniði, Ýstanbul
²Saðlýk Bilimleri Üniversitesi, Þiþli Hamidiye Etfal Eðitim ve Araþtýrma Hastanesi, Genel Cerrahi Kliniði, Ýstanbul
³Saðlýk Bilimleri Üniversitesi, Þiþli Hamidiye Etfal Eðitim ve Araþtýrma Hastanesi, Ýç Hastalýklarý Anabilim Dalý, Endokrinoloji ve Metabolizma Bilim Dalý, Ýstanbul
⁴Bahçeþehir Üniversitesi Týp Fakültesi, Genel Cerrahi Anabilim Dalý, Ýstanbul

Amaç: Primer hiperparatiroidi (pHPT)’nin küratif tedavisi cerrahidir. Cerrahi tedavi sonrasý persistan ve nüks hastalýk geliþebilmektedir. Bu çalýþmada kliniðimizde pHPT nedeni ile cerrahi tedavi uygulanan hastalarda cerrahi kür oranýný deðerlendirmeyi amaçladýk.
Gereç ve Yöntem: Kliniðimizde 2000-2015 yýllarý arasýnda deneyimli 2 cerrah tarafýndan pHPT nedeniyle paratiroidektomi yapýlan hastalarýn verileri retrospektif olarak deðerlendirildi. Ýlk paratiroidektomi sonrasý en az 6 ay takip edilen hastalar çalýþmaya dahil edildi. Hastalarda cerrahi kür, persistan ve nüks hastalýk oranlarý deðerlendirildi.
Bulgular: Bu dönemde kliniðimizde pHPT nedeniyle opere edilen, kriterlere uygun yaþ ortalamasý 54,9+13,1 yýl olan 357 hastaya (293K, 64E) 368 giriþim uygulandý. Ýlk ameliyatta 116 hastaya (%32,5) bilateral boyun eksplorasyonu (BBE), 251 hastaya (%67,5) unilateral boyun eksplorasyonu (UBE) veya odaklanmýþ cerrahi (OC) uygulandý. Ýlk ameliyatta 343 hastada (%96,1) hastada kür saðlandý, 14 hasta (13K, 1E) (% 3,9) persistan kaldý. Preoperatif deðerlendirme sonucunda 11 hastaya ikincil cerrahi giriþim uygulandý. 10 hastaya (%90,9) UBE veya OC uygulandý, 1 hastaya parsiyel sternotomi uygulandý. Hastalarýn 10’unda kür saðlandý. Bunlarýn 3’ünde ilk ameliyatta çýkarýlmayan soliter paratiroid adenomu, 7 hastada ikinci adenom vardý. Dört hasta persistan kaldý (%1,1). Dört hastada ise takipte nüks hastalýk geliþti (%1,1). Toplam kür oraný % 97,8’di.
Sonuç: pHPT’nin definitif tek tedavisi cerrahidir. Preoperatif deðerlendirme ve uygun cerrahi planlama yapýlarak yüksek cerrahi kür elde edilebilir. Bununla birlikte özellikle çift adenoma veya ektopik yerleþime baðlý olarak p-pHPT geliþebilir. p-pHPT’li hastalarýn tekrar görüntüleme yöntemleri ile deðerlendirilip, uygun cerrahi planlama ile ikincil cerrahide yüksek kür oraný elde edilebilir ve bu da toplam cerrahi kür oranýný arttýrabilir. Nüks oraný nadirdir. (SETB-2021-03-079)

Anahtar Kelimeler: hiperparatiroidizm, persistan hastalýk, rekürren hastalýk, paratiroidektomi

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