Surgical treatment in patients with single and multiple gland primary hyperparathyroidism with the use of intraoperative parathyroid hormone monitoring: extensive single-center experience
| Autor: | Georgios Misichronis, Dimitrios G. Goulis, S. Miliaras, Kyriakos Vamvakidis, Georgios Tsoulfas, Christos Christoforides |
|---|---|
| Rok vydání: | 2019 |
| Předmět: |
Adenoma
Adult Male medicine.medical_specialty Adolescent Endocrinology Diabetes and Metabolism Parathyroid hormone 030209 endocrinology & metabolism 030204 cardiovascular system & hematology Single Center Cohort Studies Neoplasms Multiple Primary Young Adult 03 medical and health sciences 0302 clinical medicine Monitoring Intraoperative medicine Humans Statistical analysis In patient Surgical treatment Aged Retrospective Studies Aged 80 and over Parathyroidectomy business.industry General Medicine Middle Aged Surgical procedures Hyperparathyroidism Primary medicine.disease Surgery Parathyroid Neoplasms Parathyroid Hormone Female business Primary hyperparathyroidism Follow-Up Studies Cohort study |
| Zdroj: | Hormones. 18:273-279 |
| ISSN: | 2520-8721 1109-3099 |
| DOI: | 10.1007/s42000-019-00121-9 |
| Popis: | To evaluate a single-center extensive experience and effectiveness in surgical treatment of primary hyperparathyroidism (pHPT) with the use of rapid intraoperative parathyroid hormone (ioPTH) monitoring in patients with single gland (SGpH) or multiple gland (MGpH) disease. This retrospective, single-center cohort study included 214 patients with pHPT treated from January 2010 to June 2017. In total, 172 patients fulfilled the inclusion criteria having at least one preoperative localization image study and measurement of ioPTH. Statistical analysis was made by the chi-square test and Student’s t tests. Of the 172 patients, 146 were women (85%) and 26 men (15%), with a mean age of 56.9 years; 153 (89%) had SGpH and 19 (11%) MGpH. The mean follow-up was 41.8 months. A total of 153 surgical procedures were performed as minimal invasive parathyroidectomy (MIP) based on a SGpH diagnosis; operative success was achieved in 150 cases (98%), according to ioPTH concentrations. The remainder (19 procedures) were performed as bilateral neck exploration (BNE) based on a MGpH diagnosis; operative success was achieved in 16 cases (84%). ioPTH correctly modified the initially planned operation in 26.3% of patients with MGpH. ioPTH enables the surgical treatment of patients with pHPT with focused approaches and excellent results, as it helps the surgeon to identify cases of MGpH. ioPTH adds value to cases where preoperative imaging failed to detect the affected gland or the results are inconclusive. According to the literature, its application seems to be of marginal benefit in cases in which there are two concordant preoperative imaging studies. |
| Databáze: | OpenAIRE |
| Externí odkaz: |
|
Full text from SpringerLink