Is focused minimally invasive parathyroidectomy appropriate for patients with familial primary hyperparathyroidism?

Academic Article

Abstract

  • Background. The aim of this study was to determine whether a focused minimally invasive parathyroidectomy (MIP) for patients with primary hyperparathyroidism and concordant pre-operative localization studies is appropriate for patients with a family history of the disease. Familial hyperparathyroidism may be seen as a chronic disease in which recurrence is inevitable. Patients frequently undergo subtotal or total parathyroidectomy for perceived 4-gland parathyroid hyperplasia in an attempt to reduce this risk. Controversy remains regarding whether a MIP is appropriate in this setting. Methods. Patients undergoing an MIP were identified from prospectively maintained databases. Chart review confirmed the presence of a family history of hyperparathyroidism in a direct relative. Patients with and without a family history were compared regarding overall complications, recurrence, and cure rates. Results. A total of 1,652 patients underwent a MIP. Of these, 34 patients had a positive family history. There was no statistically significant difference in age, gender, preoperative biochemistry, gland weight, or complication rates between the groups. The cure rate at 6 months from a single operation was equivalent between the 2 groups (97 vs. 98%). With a median of 39 months follow-up, the recurrence rate was higher in those with a family history compared with those without (8.8 vs 1.1%; P = 0.002). Reoperation was successful in the small population of familial patients who did present with recurrent hyperparathyroidism. Conclusions. The vast majority of patients who underwent a MIP were surgically cured. Although recurrence rates remain higher in the familial hyperparathyroidism group, these data suggest that this alone should not be a contraindication to MIP. © Society of Surgical Oncology 2011.
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    Author List

  • Prichard RS; O'Neill CJ; Oucharek JJ; Sippel RS; Delbridge LW; Sidhu SB; Chen H
  • Start Page

  • 1264
  • End Page

  • 1268
  • Volume

  • 19
  • Issue

  • 4