Clinical surgery-American
Negative preoperative localization leads to greater resource use in the era of minimally invasive parathyroidectomy

Presented at the New York Surgical Society Meeting, February 7, 2007, New York, NY.
https://doi.org/10.1016/j.amjsurg.2008.04.023Get rights and content

Abstract

Background

Successful preoperative localization plays an important role in patient selection for focused parathyroidectomy.

Methods

The case records of 499 consecutive patients with presumed hyperparathyroidism who underwent neck exploration were reviewed. Positive imaging patients (n = 373) had a localizing study that clearly showed a single abnormal parathyroid gland whereas negative imaging patients (n = 44) failed to localize or had discordant imaging results.

Results

Positive imaging patients were more likely to have a single adenoma (93.0% vs 72.1%; P < .001), and were less likely to require a bilateral exploration (8.1% vs 70.4%; P < .001). Negative imaging patients required more frozen sections (.9 ± 1.3 vs .2 ± .7; P < .001), and longer surgical time (77.3 ± 52.5 min vs 48.4 ± 34.6 min; P < .001). The cure rate was significantly higher in the positive imaging group (96.0% vs 87.1%; P < .03), with no difference in the incidence of complications (3.2% vs 2.3%; P value was not significant).

Conclusions

Patients with unsuccessful or discordant preoperative localization have a higher incidence of multigland disease, lower cure rate, and consume more institutional resources than patients with successful preoperative localization.

Section snippets

Methods

Permission was obtained from the Institutional Review Board of Columbia University to conduct a retrospective review of the Division of Gastrointestinal and Endocrine Surgery's Parathyroid Registry. Because of the retrospective nature of the study, the need for informed consent was waived. Data were exported from the Parathyroid Registry in a de-identified manner so that patient confidentiality was maintained.

The case records of 499 consecutive patients who underwent neck exploration for

Results

When comparing the negative and positive imaging groups, there were no differences in patient age (mean age, 58 y; range, 23–80 y vs 58 y; range, 12–92 y), sex (88% vs 78% women), preoperative mean calcium level (11.0 ± .8 mg/dL vs 11.3 ± .9 mg/dL), and PTH levels (129 ± 60 pg/mL vs 167 ± 63 pg/mL).

Neck exploration was performed under local anesthesia in 79.5% of positive imaging patients and 72.1% of negative imaging patients (P = not significant [NS]), with a similar rate of conversion to

Comments

In this study, we compared the outcomes of patients with positive preoperative localization with those with negative or discordant localization. This study and others have shown that PHPT patients with negative imaging often are more complex and difficult to treat.3, 19 In this subset of patients, there was a higher incidence of multigland disease and a higher rate of persistent hyperparathyroidism. Thus, in most cases, patients with unsuccessful localization before surgery require bilateral

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