Med Bull Sisli Etfal Hosp. 2023; 57(2): 272-278 | DOI: 10.14744/SEMB.2023.48991

Intraoperative Parathyroid Hormone Monitoring-Guided Subtotal Parathyroidectomy is an Effective and Valid Surgical Procedure for Secondary Hyperparathyroidism

Gokmen Guzel¹, Demet Saridemir Unal², Anil Ozen², Mustafa Aydemir³, Hasan Calis², Adil Boz⁴, Cumhur Arici^2
1Department of General Surgery, Serik State Hospital, Antalya, Türkiye
²Department of General Surgery, Akdeniz University Faculty of Medicine, Antalya, Türkiye
³Department of Endocrine and Metabolism, Akdeniz University Faculty of Medicine, Antalya, Türkiye
⁴Department of Nuclear Medicine, Akdeniz University Faculty of Medicine, Antalya, Türkiye

Objectives: Secondary hyperparathyroidism (sHPT) is a prevalent complication of end stage renal disease in which serious morbid conditions and mortality can be encountered. Although the best solution of this severe problem is renal transplantation, because of the huge demand and limited resources, this cannot be possible most of the time. Initial treatment alternative is medical treatment in patients with sHPT and parathyroidectomy (PTX) should be applied if does not help. Subtotal PTX, total PTX and total PTX together with autotransplantation are the current surgical options preferred for sHPT. Intraoperative parathyroid hormone (IO PTH) monitoring can increase surgical success in sHPT. We aimed to determine the ideal surgical technique and relation of IO PTH monitoring with surgical success in patients with sHPT through our study.
Methods: We analyzed all the data of the 35 patients who had PTX and follow up between January 2001 and December 2021 because of sHPT at General Surgery Department of Akdeniz University Medical Faculty Hospital in retrospective manner.
Results: Twenty-seven of the patients had been applied subtotal PTX while six of the cases had experienced limited surgery and two of them had undergone total PTX. Persistance happened to be present in the follow-up of nine patients and recurrence in one of them. Four persistant and one recurrent cases were present in 23 patients with IO PTH monitoring (78.3% surgical success), while there were persistences in each of the three patients with no IO PTH monitoring (0% success of surgery) (p=0.022). IO PTH monitoring data of nine patients could not be reached. In this study, 20 patients had IO PTH decline of 80% or more (90% surgical success) and three patients had IO PTH decline below 80% (0% surgical success) (p=0.006). Subtotal PTX was applied to 17 (94.1% surgical success) of these 20 patients.
Conclusion: In surgical treatment of patients with sHPT, IO PTH monitoring should be maintained and operation should not be finished until 80% or more decline in IO PTH level had been detected. Among the surgical alternatives for sHPT, subtotal PTX appears as an effective and valid method when performed together with IO PTH monitoring, provided that there is a decline in PTH level of 80% or more.

Keywords: Intraoperative parathyroid hormone monitoring, parathyroidectomy, secondary hyperparathyroidism

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Ýntraoperatif Paratiroid Hormon Monitorizasyonu Rehberliðinde Subtotal Paratiroidektomi Sekonder Hiperparatiroidizm için Etkili ve Geçerli bir Cerrahi Prosedürdür

Gokmen Guzel¹, Demet Saridemir Unal², Anil Ozen², Mustafa Aydemir³, Hasan Calis², Adil Boz⁴, Cumhur Arici^2
1Serik Devlet Hastanesi, Genel Cerrahi Kliniði, Antalya
²Akdeniz Üniversitesi Týp Fakültesi Genel Cerrahi Ana Bilim Dalý, Antalya
³Akdeniz Üniversitesi Týp Fakültesi Endokrin ve Metabolizma Ana Bilim Dalý, Antalya
⁴Akdeniz Üniversitesi Týp Fakültesi Nükleer Týp Ana Bilim Dalý, Antalya

Amaç: Sekonder hiperparatiroizm (sHPT) son evre böbrek yetmezliðinin, ciddi morbid durumlar ve mortaliteyle karþýlaþýlabilen, yaygýn bir komplikasyonudur. Bu ciddi problemin en iyi çözümü renal transplantasyon (RTX) olsa da, yoðun talep ve sýnýrlý kaynaklar nedeniyle çoðu zaman bu mümkün olamamaktadýr. sHPT’li hastalarda ilk tedavi alternatifi medikal tedavidir ve fayda etmezse paratiroidektomi (PTX) uygulanmalýdýr. Subtotal PTX, total PTX ve total PTX ile birlikte ototransplantasyon (AT), sHPT için tercih edilen geçerli cerrahi seçeneklerdir. Intraoperatif parathormon (IO PTH) monitorizasyonu, sHPT’de cerrahi baþarýyý arttýrabilmektedir. Çalýþmamýz ile sHPT’li hastalarda ideal cerrahi tekniði ve IO PTH monitorizasyonunun cerrahi baþarý ile iliþkisini deðerlendirmeyi amaçladýk.
Metod: Akdeniz Üniversitesi Týp Fakültesi Hastanesi Genel Cerrahi Kliniðinde Ocak 2001- Aralýk 2021 döneminde sHPT sebebiyle ameliyat edilip takip edilen 35 hastanýn tüm verilerini retrospektif olarak analiz ettik.
Bulgular: Hastalarýn 27 tanesine subtotal PTX uygulanýrken, 6 hastaya sýnýrlý cerrahi (SC), 2 hastaya ise total PTX gerçekleþtirildi. Takip döneminde 9 hastada persistans, 1 hastada ise rekürrens gözlendi. IO PTH monitorizasyonu uygulanmýþ 23 hastada 4 persistans ve 1 rekürrens (%78.3 cerrahi baþarý) saptanýrken, IO PTH monitorizasyonu uygulanmayan 3 hastanýn ise herbirinde persistans geliþtiði görüldü (%0 cerrahi baþarý) (p=0.022). 9 hastada IO PTH monitorizasyon verisine ulaþýlamadý. Bu çalýþmada, 20 hastada IO PTH düzeyinde %80 ve üzerinde düþüþ (%90 cerrahi baþarý) görülürken, 3 hastada ise düþüþ %80’nin altýndaydý (%0 cerrahi baþarý) (p=0.006). Bu 20 hastanýn 17 (%94.1 cerrahi baþarý)’e Subtotal PTX uygulanmýþtý.
Sonuç: sHPT’nin cerrahi tedavisinde IO PTH monitorizasyonu yapýlmalý ve IO PTH düzeyinde %80 ve üzerinde düþüþ görülmeden de ameliyat sonlandýrýlmamalýdýr. sHPT’nin cerrahi seçenekleri arasýnda da; IO PTH monitorizasyonu ile birlikte yapýlan subtotal PTX, %80 ve üzerinde IO PTH düþüþü görülmesi kaydýyla, etkili ve geçerli bir cerrahi yöntemdir. (SETB-2023-04-060)

Anahtar Kelimeler: Ýntraoperatif parathormon monitorizasyonu, paratiroidektomi, sekonder hiperparatiroidizm

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