Concise parathyroidectomy: The impact of preoperative SPECT 99mTc sestamibi scanning and intraoperative quick parathormone assay
| Autor: | M.Jonathan Worsey, Mohamed A. Virji, Sally E. Carty, Charles G. Watson, Manuel L. Brown |
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| Rok vydání: | 1997 |
| Předmět: |
Adult
Male Technetium Tc 99m Sestamibi Parathyroidectomy medicine.medical_specialty medicine.medical_treatment Single-photon emission computed tomography Palpation Technetium (99mTc) sestamibi Intraoperative Period Spect imaging medicine Humans Aged Tomography Emission-Computed Single-Photon Hyperparathyroidism medicine.diagnostic_test business.industry Perioperative Length of Stay Middle Aged medicine.disease Surgery Parathyroid Hormone Female business Primary hyperparathyroidism medicine.drug |
| Zdroj: | Surgery. 122:1107-1116 |
| ISSN: | 0039-6060 |
| DOI: | 10.1016/s0039-6060(97)90215-4 |
| Popis: | Background. Results of initial operation for sporadic primary hyperparathyroidism are generally excellent, yet today there is pressure to improve outcome and resource utilization. Methods. We designed a prospective longitudinal cohort study comparing two approaches to concise parathyroidectomy. Strategy A was defined as the palpation method for selective unilateral exploration. Strategy B was defined as the routine use of both preoperative 99mTc sestamibi single photon emission computed tomography (SPECT) imaging and intraoperative quick parathormone assay. With either strategy the study period was 19 months and patients explored unilaterally were candidates for same-day discharge. We compared surgical outcome for 128 consecutive consenting patients each with 6 months or more of follow-up (mean 12 ± 7.6 months). Results. Demographic, biochemical, and pathologic findings did not differ between groups. SPECT imaging precisely localized hyperfunctioning parathyroid tissue. Compared with Strategy A (n = 61), the 67 patients treated by use of Strategy B experienced a higher rate of unilateral exploration (41.0% versus 62.7%, p < 0.00001) and a shorter length of stay (1.07 versus 1.90 days, p < 0.00001) and tended to have shorter operative times, fewer operative failures, and less morbidity. Total perioperative costs did not differ between groups. Conclusions. Routine use of intraoperative quick parathormone measurement and preoperative 99mTc sestamibi SPECT is as safe, effective, and cost-effective as conventional approaches to parathyroidectomy. Use of this strategy is associated with significant reductions in extent of surgery and length of hospital stay. |
| Databáze: | OpenAIRE |
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