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Surgical treatment of secondary hyperparathyroidism in elderly patients : an institutional experience

Polistena, Andrea LU ; Sanguinetti, Alessandro; Lucchini, Roberta; Galasse, Segio; Avenia, Stefano; Monacelli, Massimo; Johnson, Louis Banka LU ; Jeppsson, Bengt LU and Avenia, Nicola (2017) In Aging clinical and experimental research 29(suppl. 1). p.23-28
Abstract

Background: Secondary hyperparathyroidism in elderly fragile patients presents clinical difficulties due to severity of symptoms and related comorbidity. The optimal surgical approach for this group of patients is still debated. Aim: The aim of the study was to define the optimal technique of parathyroidectomy in elderly patients with secondary hyperparathyroidism. Methods: Retrospective analysis in a series of 253 patients including 35 elderly individuals at a single institution was carried out. Postoperative parathyroid hormone decrease, surgical complications and symptoms control were analyzed for all patients in relation to the types of parathyroidectomy performed. Results: In elderly patients, total parathyroidectomy was the most... (More)

Background: Secondary hyperparathyroidism in elderly fragile patients presents clinical difficulties due to severity of symptoms and related comorbidity. The optimal surgical approach for this group of patients is still debated. Aim: The aim of the study was to define the optimal technique of parathyroidectomy in elderly patients with secondary hyperparathyroidism. Methods: Retrospective analysis in a series of 253 patients including 35 elderly individuals at a single institution was carried out. Postoperative parathyroid hormone decrease, surgical complications and symptoms control were analyzed for all patients in relation to the types of parathyroidectomy performed. Results: In elderly patients, total parathyroidectomy was the most used approach. Subtotal parathyroidectomy was mostly reserved for younger patients suitable for kidney transplantation. No elderly patients treated with total parathyroidectomy were autotransplanted. No significant difference in surgical complications was observed between younger and elderly patients and considering the different procedures. Adequate symptom control after surgery was achieved in almost 90% of patients. A limited rate of recurrence requiring repeat surgery was observed only after subtotal parathyroidectomy. Discussion: Considering the features of all types of parathyroidectomy, very low recurrence rate, contained postoperative hypocalcemia and limited complications following total parathyroidectomy, might represent specific advantages for elderly patients. Conclusions: Total parathyroidectomy without parathyroid transplantation is safe for elderly patients with secondary hyperparathyroidism and a good alternative to the well-established total parathyroidectomy with autografting.

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author
organization
publishing date
type
Contribution to journal
publication status
published
subject
keywords
Elderly, Parathyroid autotransplantation, Secondary hyperparathyroidism, Subtotal parathyroidectomy, Total parathyroidectomy
in
Aging clinical and experimental research
volume
29
issue
suppl. 1
pages
23 - 28
publisher
Kurtis
external identifiers
  • scopus:84994471155
  • wos:000396128300004
ISSN
1594-0667
DOI
10.1007/s40520-016-0669-4
language
English
LU publication?
yes
id
b1b05047-afe9-47f1-8ab3-9daa6b8fc0e5
date added to LUP
2016-11-28 14:48:42
date last changed
2018-01-07 11:37:26
@article{b1b05047-afe9-47f1-8ab3-9daa6b8fc0e5,
  abstract     = {<p>Background: Secondary hyperparathyroidism in elderly fragile patients presents clinical difficulties due to severity of symptoms and related comorbidity. The optimal surgical approach for this group of patients is still debated. Aim: The aim of the study was to define the optimal technique of parathyroidectomy in elderly patients with secondary hyperparathyroidism. Methods: Retrospective analysis in a series of 253 patients including 35 elderly individuals at a single institution was carried out. Postoperative parathyroid hormone decrease, surgical complications and symptoms control were analyzed for all patients in relation to the types of parathyroidectomy performed. Results: In elderly patients, total parathyroidectomy was the most used approach. Subtotal parathyroidectomy was mostly reserved for younger patients suitable for kidney transplantation. No elderly patients treated with total parathyroidectomy were autotransplanted. No significant difference in surgical complications was observed between younger and elderly patients and considering the different procedures. Adequate symptom control after surgery was achieved in almost 90% of patients. A limited rate of recurrence requiring repeat surgery was observed only after subtotal parathyroidectomy. Discussion: Considering the features of all types of parathyroidectomy, very low recurrence rate, contained postoperative hypocalcemia and limited complications following total parathyroidectomy, might represent specific advantages for elderly patients. Conclusions: Total parathyroidectomy without parathyroid transplantation is safe for elderly patients with secondary hyperparathyroidism and a good alternative to the well-established total parathyroidectomy with autografting.</p>},
  author       = {Polistena, Andrea and Sanguinetti, Alessandro and Lucchini, Roberta and Galasse, Segio and Avenia, Stefano and Monacelli, Massimo and Johnson, Louis Banka and Jeppsson, Bengt and Avenia, Nicola},
  issn         = {1594-0667},
  keyword      = {Elderly,Parathyroid autotransplantation,Secondary hyperparathyroidism,Subtotal parathyroidectomy,Total parathyroidectomy},
  language     = {eng},
  number       = {suppl. 1},
  pages        = {23--28},
  publisher    = {Kurtis},
  series       = {Aging clinical and experimental research},
  title        = {Surgical treatment of secondary hyperparathyroidism in elderly patients : an institutional experience},
  url          = {http://dx.doi.org/10.1007/s40520-016-0669-4},
  volume       = {29},
  year         = {2017},
}