Hostname: page-component-745bb68f8f-lrblm Total loading time: 0 Render date: 2025-01-11T23:28:41.781Z Has data issue: false hasContentIssue false
  • English
  • Français

Revision parathyroid surgery – challenges and considerations in comparison to primary surgery

Published online by Cambridge University Press:  20 March 2023

A McClean Open the ORCID record for A McClean [Opens in a new window]  and
R J A England
A McClean*
Affiliation:
Plastic and Reconstructive Surgery, Hull University Teaching Hospitals NHS Trust, Hull, UK
R J A England
Affiliation:
ENT, Hull University Teaching Hospitals NHS Trust, Hull, UK
*
Corresponding author: Adam McClean; Email: [email protected]
Get access Rights & Permissions [Opens in a new window]

Abstract

Objective

Revision parathyroidectomy is made necessary by recurrent or persistent parathyroid disease. This study aimed to identify challenges in revision surgery compared to primary parathyroid surgery.

Methods

All revision parathyroidectomies performed by one surgeon over a 17-year period were assessed for demographics, imaging, histology, biochemistry, cure rate, gland weight, gland location and gland ectopia, and compared to a series of 100 primary parathyroidectomies.

Results

Twenty-eight revision surgical procedures were identified. Sestamibi scanning for gland localisation was superior to ultrasound in both primary and revision surgery. Pre-operative calcium and gland weight were significantly higher in revision cases. There were no significant differences in post-operative calcium levels, pre- or post-operative parathyroid hormone levels, or gland location. 36 per cent of glands excised in revision surgery were ectopic, compared to 25 per cent in primary procedures. The cure rate was significantly lower in revision surgery.

Conclusion

Revision parathyroidectomy patients present with higher pre-operative calcium and larger adenomas; the cure rate is significantly lower in these patients.

Keywords

Parathyroid neoplasmsparathyroid diseasesparathyroid disordersrevision surgery
Type
Main Article
Information
The Journal of Laryngology & Otology , Volume 137 , Issue 11 , November 2023 , pp. 1233 - 1236
Copyright
Copyright © The Author(s), 2023. Published by Cambridge University Press on behalf of J.L.O. (1984) LIMITED

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

Footnotes

Dr A McClean takes responsibility for the integrity of the content of the paper

Data presented in part at the British Association of Endocrine and Thyroid Surgeons Meeting, 7–8 October 2021, Leeds, UK.

References

Udelsman, R, Lin, Z, Donovan, P. The superiority of minimally invasive parathyroidectomy based on 1650 consecutive patients with primary hyperparathyroidism. Ann Surg 2011;253:701–3CrossRefGoogle ScholarPubMed
Reeve, TS, Babidge, WJ, Parkyn, RF, Edis, AJ, Delbridge, LW, Devitt, PG et al. Minimally invasive surgery for primary hyperparathyroidism: a systematic review. Aust N Z J Surg 2000;70:244–50CrossRefGoogle ScholarPubMed
Ishii, H, Mihai, R, Watkinson, JC, Kim, DS. Systematic review of cure and recurrence rates following minimally invasive parathyroidectomy. BJS Open 2018;2:364–70CrossRefGoogle ScholarPubMed
Goldfarb, M, Singer, FR. Recent advances in the understanding and management of primary hyperparathyroidism. F1000Res 2020;9:143CrossRefGoogle ScholarPubMed
Guerin, C, Paladino, NC, Lowery, A, Castinetti, F, Taieb, D, Sebag, F. Persistent and recurrent hyperparathyroidism. Updates Surg 2017;69:161–9CrossRefGoogle ScholarPubMed
Venkat, R, Kouniavsky, G, Tufano, RP, Schneider, EB, Dackiw, APB, Zeiger, MA. Long-term outcome in patients with primary hyperparathyroidism who underwent minimally invasive parathyroidectomy. World J Surg 2012;36:55–60CrossRefGoogle ScholarPubMed
Gough, I. Reoperative parathyroid surgery: the importance of ectopic location and multigland disease. ANZ J Surg 2006;76:1048–50CrossRefGoogle ScholarPubMed
Kollmorgen, CF, Aust, MR, Ferreiro, JA, McCarthy, JT, van Heerden, JA. Parathyromatosis: a rare yet important cause of persistent or recurrent hyperparathyroidism. Surgery 1994;116:111–15Google ScholarPubMed
Mihai, R, Barczynski, M, Iacobone, M, Sitges-Serra, A. Surgical strategy for sporadic primary hyperparathyroidism an evidence-based approach to surgical strategy, patient selection, surgical access, and reoperations. Langenbecks Arch Surg 2009;394:785–98CrossRefGoogle ScholarPubMed
Cham, S, Sepahdari, AR, Hall, KE, Yeh, MW, Harari, A. Dynamic parathyroid computed tomography (4DCT) facilitates reoperative parathyroidectomy and enables cure of missed hyperplasia. Ann Surg Oncol 2015;22:3537–42CrossRefGoogle ScholarPubMed
Stack, BCJ, Tolley, NS, Bartel, TB, Bilezikian, JP, Bodenner, D, Camacho, P et al. AHNS Series: do you know your guidelines? Optimizing outcomes in reoperative parathyroid surgery: definitive multidisciplinary joint consensus guidelines of the American Head and Neck Society and the British Association of Endocrine and Thyroid Surgeons. Head Neck 2018;40:1617–29CrossRefGoogle Scholar
Shin, JJ, Milas, M, Mitchell, J, Berber, E, Ross, L, Siperstein, A. Impact of localization studies and clinical scenario in patients with hyperparathyroidism being evaluated for reoperative neck surgery. Arch Surg 2011;146:1397–403CrossRefGoogle ScholarPubMed
Thomas, DL, Bartel, T, Menda, Y, Howe, J, Graham, MM, Juweid, ME. Single photon emission computed tomography (SPECT) should be routinely performed for the detection of parathyroid abnormalities utilizing technetium-99m sestamibi parathyroid scintigraphy. Clin Nucl Med 2009;34:651–5CrossRefGoogle ScholarPubMed
Chen, H, Mack, E, Starling, JR. A comprehensive evaluation of perioperative adjuncts during minimally invasive parathyroidectomy: which is most reliable? Ann Surg 2005;242:373–5CrossRefGoogle ScholarPubMed
Thompson, GB, Grant, CS, Perrier, ND, Harman, R, Hodgson, SF, Ilstrup, D et al. Reoperative parathyroid surgery in the era of sestamibi scanning and intraoperative parathyroid hormone monitoring. Arch Surg 1999;134:699–705CrossRefGoogle ScholarPubMed
Lal, A, Chen, H. The negative sestamibi scan: is a minimally invasive parathyroidectomy still possible? Ann Surg Oncol 2007;14:2363–6CrossRefGoogle ScholarPubMed
Agha, A, Hornung, M, Schlitt, HJ, Stroszczynski, C, Jung, E-M. The role of contrast-enhanced ultrasonography (CEUS) in comparison with 99mTechnetium-sestamibi scintigraphy for localization diagnostic of primary hyperparathyroidism. Clin Hemorheol Microcirc 2014;58:515–20CrossRefGoogle ScholarPubMed
Soon, PSH, Delbridge, LW, Sywak, MS, Barraclough, BM, Edhouse, P, Sidhu, SB. Surgeon performed ultrasound facilitates minimally invasive parathyroidectomy by the focused lateral mini-incision approach. World J Surg 2008;32:766–71CrossRefGoogle ScholarPubMed
Scattergood, S, Marsden, M, Kyrimi, E, Ishii, H, Doddi, S, Sinha, P. Combined ultrasound and sestamibi scintigraphy provides accurate preoperative localisation for patients with primary hyperparathyroidism. Ann R Coll Surg Engl 2018;101:97–102CrossRefGoogle ScholarPubMed
Merchavy, S, Luckman, J, Guindy, M, Segev, Y, Khafif, A. 4D MRI for the localization of parathyroid adenoma: a novel method in evolution. Otolaryngol Head Neck Surg 2016;154:446–8CrossRefGoogle ScholarPubMed
Hinson, AM, Lee, DR, Hobbs, BA, Fitzgerald, RT, Bodenner, DL, Stack, BCJ. Preoperative 4D CT localization of nonlocalizing parathyroid adenomas by ultrasound and SPECT-CT. Otolaryngol Head Neck Surg 2015;153:775–8CrossRefGoogle ScholarPubMed
Mortenson, MM, Evans, DB, Lee, JE, Hunter, GJ, Shellingerhout, D, Vu, T et al. Parathyroid exploration in the reoperative neck: improved preoperative localization with 4D-computed tomography. J Am Coll Surg 2008;206:886–8CrossRefGoogle ScholarPubMed
McIntyre, CJ, Allen, JLY, Constantinides, VA, Jackson, JE, Tolley, NS, Palazzo, FF. Patterns of disease in patients at a tertiary referral centre requiring reoperative parathyroidectomy. Ann R Coll Surg Engl 2015;97:598–602CrossRefGoogle Scholar
Moretz, WH 3rd, Watts, TL, Virgin, FW Jr, Chin, E, Gourin, CG, Terris, DJ. Correlation of intraoperative parathyroid hormone levels with parathyroid gland size. Laryngoscope 2007;117:1957–60CrossRefGoogle ScholarPubMed
Rao, DS, Honasoge, M, Divine, GW, Phillips, ER, Lee, MW, Ansari, MR et al. Effect of vitamin D nutrition on parathyroid adenoma weight: pathogenetic and clinical implications. J Clin Endocrinol Metab 2000;85:1054–8Google ScholarPubMed