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Unilateral versus bilateral neck exploration for primary hyperparathyroidism - Five-year follow-up of a randomized controlled trial

Westerdahl, Johan LU and Bergenfelz, Anders LU (2007) In Annals of Surgery 246(6). p.976-981
Abstract
Objective: To compare long-term patient outcome in a prospective randomized controlled trial between unilateral and bilateral neck exploration for primary hyperparathyroidism (pHPT). Summary Background Data: Minimal invasive and/or focused parathyroidectomy has challenged the traditional bilateral neck exploration for pHPT. Between 1997 and 2001, we conducted the first unselected randomized controlled trial of unilateral versus bilateral neck exploration for pHPT. The results showed that unilateral exploration is a surgical strategy with distinct advantages in the early postoperative period. However, concerns have been raised that limited parathyroid exploration could increase the risk for recurrent pHPT during long-term follow-up.... (More)
Objective: To compare long-term patient outcome in a prospective randomized controlled trial between unilateral and bilateral neck exploration for primary hyperparathyroidism (pHPT). Summary Background Data: Minimal invasive and/or focused parathyroidectomy has challenged the traditional bilateral neck exploration for pHPT. Between 1997 and 2001, we conducted the first unselected randomized controlled trial of unilateral versus bilateral neck exploration for pHPT. The results showed that unilateral exploration is a surgical strategy with distinct advantages in the early postoperative period. However, concerns have been raised that limited parathyroid exploration could increase the risk for recurrent pHPT during long-term follow-up. Methods: Ninety-one patients with the diagnosis of pHPT were randomized to unilateral or bilateral neck exploration. Preoperative scintigraphy and intraoperative parathyroid hormone measurement guided the unilateral exploration. Gross morphology and frozen section determined the extent of parathyroid tissue resection in the bilateral group. Follow-up was performed after 6 weeks, I year, and 5 years postoperatively. Results: Seventy-one patients were available for 5-year follow-up. There were no differences in serum ionized calcium and parathyroid hormone, respectively, between patients in the unilateral and bilateral group. Overall 6 patients have been found to have persistent (n = 3) or recurrent (n = 3) pHPT; 4 patients in the unilateral group (3 of these 4 patients were bilaterally explored) and 2 patients in the bilateral group. Three of 6 failures were unexpectedly found to have multiple endocrine neoplasia mutations. One patient with solitary adenoma in the bilateral group still required vitamin D substitution 5 years after surgery. Conclusion: Unilateral neck exploration with intraoperative parathyroid hormone assessment provides the same long-term results as bilateral neck exploration, and is thus a valid strategy for the surgical treatment of pHPT. (Less)
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author
organization
publishing date
type
Contribution to journal
publication status
published
subject
in
Annals of Surgery
volume
246
issue
6
pages
976 - 981
publisher
Lippincott Williams & Wilkins
external identifiers
  • wos:000251638000011
  • scopus:36549076967
ISSN
1528-1140
DOI
10.1097/SLA.0b013e31815c3ffd
language
English
LU publication?
yes
id
2c0ae38f-71c8-4ecc-a1ea-10106d32f5be (old id 966207)
alternative location
http://www.annalsofsurgery.com/pt/re/annos/abstract.00000658-200712000-00009.htm
date added to LUP
2008-01-30 15:44:04
date last changed
2017-11-19 03:25:40
@article{2c0ae38f-71c8-4ecc-a1ea-10106d32f5be,
  abstract     = {Objective: To compare long-term patient outcome in a prospective randomized controlled trial between unilateral and bilateral neck exploration for primary hyperparathyroidism (pHPT). Summary Background Data: Minimal invasive and/or focused parathyroidectomy has challenged the traditional bilateral neck exploration for pHPT. Between 1997 and 2001, we conducted the first unselected randomized controlled trial of unilateral versus bilateral neck exploration for pHPT. The results showed that unilateral exploration is a surgical strategy with distinct advantages in the early postoperative period. However, concerns have been raised that limited parathyroid exploration could increase the risk for recurrent pHPT during long-term follow-up. Methods: Ninety-one patients with the diagnosis of pHPT were randomized to unilateral or bilateral neck exploration. Preoperative scintigraphy and intraoperative parathyroid hormone measurement guided the unilateral exploration. Gross morphology and frozen section determined the extent of parathyroid tissue resection in the bilateral group. Follow-up was performed after 6 weeks, I year, and 5 years postoperatively. Results: Seventy-one patients were available for 5-year follow-up. There were no differences in serum ionized calcium and parathyroid hormone, respectively, between patients in the unilateral and bilateral group. Overall 6 patients have been found to have persistent (n = 3) or recurrent (n = 3) pHPT; 4 patients in the unilateral group (3 of these 4 patients were bilaterally explored) and 2 patients in the bilateral group. Three of 6 failures were unexpectedly found to have multiple endocrine neoplasia mutations. One patient with solitary adenoma in the bilateral group still required vitamin D substitution 5 years after surgery. Conclusion: Unilateral neck exploration with intraoperative parathyroid hormone assessment provides the same long-term results as bilateral neck exploration, and is thus a valid strategy for the surgical treatment of pHPT.},
  author       = {Westerdahl, Johan and Bergenfelz, Anders},
  issn         = {1528-1140},
  language     = {eng},
  number       = {6},
  pages        = {976--981},
  publisher    = {Lippincott Williams & Wilkins},
  series       = {Annals of Surgery},
  title        = {Unilateral versus bilateral neck exploration for primary hyperparathyroidism - Five-year follow-up of a randomized controlled trial},
  url          = {http://dx.doi.org/10.1097/SLA.0b013e31815c3ffd},
  volume       = {246},
  year         = {2007},
}