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Bioscience Trends Dec 2022Kidney transplantation remains the best treatment for patients with end-stage kidney disease, and it could partially mitigate systemic disorders of mineral and bone... (Review)
Review
Kidney transplantation remains the best treatment for patients with end-stage kidney disease, and it could partially mitigate systemic disorders of mineral and bone metabolism caused by secondary hyperparathyroidism. However, persistent hyperparathyroidism is still observed in 30-60% of patients 1 year after kidney transplantation, leading to impairment of allograft function and a disturbance of mineral metabolism. The timing of parathyroidectomy varies among transplant centers because the possible negative effects of parathyroidectomy on allograft outcomes are still unclear. This review provides a comprehensive and detailed overview of the natural course of hyperparathyroidism following kidney transplantation and the effects of the timing and extent of parathyroidectomy on allograft function. It aims to provide useful information for surgeons to propose an appropriate intervention strategy to break the vicious cycle of post-kidney transplantation hyperparathyroidism and deterioration of allograft function.
Topics: Humans; Kidney Transplantation; Parathyroidectomy; Hyperparathyroidism, Secondary; Minerals; Transplants; Retrospective Studies
PubMed: 36403958
DOI: 10.5582/bst.2022.01320 -
International Journal of Surgery... Mar 2015A best evidence topic was written according to a structured protocol. The question addressed was whether robotic parathyroidectomy (RP) is a feasible and safe... (Comparative Study)
Comparative Study Review
A best evidence topic was written according to a structured protocol. The question addressed was whether robotic parathyroidectomy (RP) is a feasible and safe alternative to targeted open parathyroidectomy for the treatment of primary hyperparathyroidism (pHPT). A total of 36 papers were identified using the reported searches of which 5 represented the best evidence to answer the clinical question. The authors, date, journal, study type, population, main outcome measures and results are tabulated. Targeted parathyroidectomy constitutes the co-gold-standard procedure for pHPT with results equivalent to bilateral cervical exploration. This has led to the proliferation of minimally invasive parathyroidectomy (MIP) techniques for pre-operatively localised adenomas. None has been shown to be overwhelmingly superior. RP constitutes the most recent addition. RP overcomes the limitations of conventional endoscopic surgery and simultaneously avoids a neck scar by concealing it in the axilla or infraclavicular area. The evidence from the present review shows that RP is feasible and leads to a superior cosmetic result compared to targeted open parathyroidectomy (TOP) with an equivalent safety profile. As with every surgical technique, appropriate patient selection is crucial. Long-term data are currently awaited on RP especially in view of its high cost and long operative time compared to TOP and other MIP techniques. Hence, RP offers a viable but costly alternative to other forms of MIP in patients where even the smallest and most cosmetic neck scar is not an option.
Topics: Adenoma; Feasibility Studies; Humans; Hyperparathyroidism, Primary; Parathyroidectomy; Robotic Surgical Procedures; Treatment Outcome
PubMed: 25638734
DOI: 10.1016/j.ijsu.2015.01.019 -
ORL; Journal For Oto-rhino-laryngology... 2018Robotic parathyroidectomy represents a novel surgical approach in the treatment of primary hyperparathyroidism when the parathyroid adenoma has been pre-operatively... (Review)
Review
Robotic parathyroidectomy represents a novel surgical approach in the treatment of primary hyperparathyroidism when the parathyroid adenoma has been pre-operatively localised. It represents the "fourth generation" in the evolution of parathyroid surgery following a process of surgical evolution from cervicotomy and 4-gland exploration to a variety of minimally invasive, open and endoscopic, targeted approaches. The existing evidence (levels 2-3) supports it as a feasible and safe technique with equivalent results to targeted open parathyroidectomy for primary hyperparathyroidism in carefully selected patients. However, it takes longer to perform and is more costly than conventional parathyroidectomy. It offers superior cosmesis by completely avoiding a neck scar making it a valid option for those patients who for biological and/or cultural reasons may wish to avoid a neck scar. Robotic parathyroidectomy is not for every patient, surgeon, or hospital. Its application should be confined to high-volume centres and experienced surgeons. Intensive training and proctorship are required for its safe implementation combined with careful patient selection. This particularly relates to the patient's body habitus (BMI < 30 kg/m2) and concordance among the different imaging modalities used pre-operatively. With robotic market competition driving down costs, its role may change. For now, robotic parathyroidectomy occupies a niche role and can only be justified in a select subset of patients.
Topics: Contraindications, Procedure; Cost-Benefit Analysis; Forecasting; History, 20th Century; History, 21st Century; Humans; Operative Time; Parathyroidectomy; Robotic Surgical Procedures
PubMed: 29788003
DOI: 10.1159/000488355 -
The Indian Journal of Medical Research Jan 2022Primary hyperparathyroidism (PHPT) is a common endocrine disorder caused by the elevated secretion of the parathormone (PTH). The aim of this study was to evaluate the...
BACKGROUND & OBJECTIVES
Primary hyperparathyroidism (PHPT) is a common endocrine disorder caused by the elevated secretion of the parathormone (PTH). The aim of this study was to evaluate the haematological manifestations of PHPT in patients with normal renal functions who were treated surgically for parathyroid adenomas.
METHODS
In this retrospective cross-sectional study, 134 patients with normal renal functions who underwent parathyroidectomies for PHPT were included. The haematological manifestations were evaluated in the total study cohort and in the two groups of different calcium (Ca) levels (Group 1 ≤11.2 mg/dl and Group 2 >11.2 mg/dl).
RESULTS
The overall prevalence of anaemia, leucopenia and thrombocytopenia was 20.1, 6.7 and 6.0 per cent, respectively. Normocytic anaemia was present in 19 (14.2%) patients. There were no significant differences in the prevalence of anaemia, leucopenia and thrombocytopenia between the two groups. There were no correlations between the PTH levels and the leukocyte, haemoglobin or platelet values. Six to 12 months after the parathyroidectomy (PTX), 35.7 per cent of the patients with anaemia, 85.7 per cent of the patients with leucopenia and 100 per cent of the patients with thrombocytopenia had recovered.
INTERPRETATION & CONCLUSIONS
In the present study, anaemia was seen with a variable frequency in PHPT, but there was no relationship between anaemia and high PTH or Ca levels. The development of anaemia can be seen regardless of the PTH levels in PHPT patients with normal renal functions. High-resolution rates after PTX indicate a possible association between PHPT and thrombocytopenia or leucopenia, although their prevalence is low in PHPT.
Topics: Anemia; Calcium; Cross-Sectional Studies; Humans; Hyperparathyroidism, Primary; Parathyroid Hormone; Parathyroidectomy; Retrospective Studies; Thrombocytopenia
PubMed: 35859427
DOI: 10.4103/ijmr.IJMR_1200_19 -
Kidney International Sep 2008Yajima and co-workers investigated iliac bone biopsies taken before and after parathyroidectomy. They found enhanced de novo osteoid formation and mineral apposition at... (Review)
Review
Yajima and co-workers investigated iliac bone biopsies taken before and after parathyroidectomy. They found enhanced de novo osteoid formation and mineral apposition at trabecular sites without signs of previous bone resorption. From this finding they conclude that 'minimodeling' contributes to the increase of bone volume following parathyroidectomy. This report refines our understanding of the compensatory mechanisms by which bone mass and possibly increased mechanical stability of the skeletal apparatus are regained after parathyroidectomy.
Topics: Animals; Bone Regeneration; Bone Remodeling; Humans; Hyperparathyroidism, Secondary; Parathyroid Hormone; Parathyroidectomy; Vitamin D
PubMed: 18756293
DOI: 10.1038/ki.2008.321 -
World Journal of Surgery Jan 2021Racial disparities in surgery are increasingly recognized. We evaluated the impact of race on presentation, preoperative evaluation, and surgical outcomes for patients...
BACKGROUND
Racial disparities in surgery are increasingly recognized. We evaluated the impact of race on presentation, preoperative evaluation, and surgical outcomes for patients undergoing parathyroidectomy for primary hyperparathyroidism (PHPT).
METHODS
We performed a retrospective cohort study of patients undergoing parathyroidectomy for PHPT at a single center (1997-2015). Patients were classified by self-identified race, as African-American or White. The primary outcome was disease severity at referral. The secondary outcome was completeness of preoperative evaluation. Operative success and surgical cure were evaluated.
RESULTS
A total of 2392 patients were included. The majority of patients (87.6%) were White. African-American patients had higher rates of comorbid disease as well as higher preoperative calcium (10.9 vs.10.8 mg/dl, p < 0.001) and PTH levels (122 vs. 97 pg/ml, p < 0.001). White patients were more likely to have history of bone loss documented by DXA and nephrolithiasis. African-American patients had lower rates of complete preoperative evaluation including DXA scan. Operatively, African-American patients had larger glands by size (1.7 vs. 1.5 cm, p < 0.001) and mass (573 vs. 364 mg, p < 0.001). We observed similar operative success (98.9 vs. 98.0%, p = 0.355) and cure rates (98.3 vs. 97.0%, p = 0.756).
CONCLUSIONS
At the time of surgical referral, African-American patients with PHPT have more biochemically severe disease and higher rates of incomplete evaluation. Operative success and cure rates are comparable.
Topics: Black or African American; Aged; Female; Health Status Disparities; Healthcare Disparities; Humans; Hyperparathyroidism, Primary; Male; Middle Aged; Parathyroid Hormone; Parathyroidectomy; Preoperative Care; Retrospective Studies; Severity of Illness Index; United States; White People
PubMed: 32978665
DOI: 10.1007/s00268-020-05791-w -
The Israel Medical Association Journal... Jan 2022
Topics: Adult; Aged; Atrial Fibrillation; Female; Humans; Male; Parathyroidectomy; Postoperative Complications; Thyrotoxicosis
PubMed: 35077050
DOI: No ID Found -
International Journal of Surgery... Oct 2019Thermal ablation and parathyroidectomy (PTX) have been recommended for patients with secondary hyperparathyroidism (SHPT). However, it is uncertain which is the better... (Comparative Study)
Comparative Study Review
OBJECTIVE
Thermal ablation and parathyroidectomy (PTX) have been recommended for patients with secondary hyperparathyroidism (SHPT). However, it is uncertain which is the better method. The aim of the present meta-analysis was to evaluate the efficacy and surgical complications of the two treatment methods.
METHODS
The following databases were searched from inception to December 31, 2018: PubMed, EMBASE, the Cochrane Library, CNKI, and Wanfang. Eligible studies comparing thermal ablation and PTX for SHPT were included. Data were analysed using Review Manager Version 5.3.
RESULTS
Six studies were included in the meta-analysis. Four cohort studies and two randomized controlled trials involving 326 patients with SHPT were identified. There was no difference concerning parathyroid hormone (PTH) levels (MD 58.04, 95% CI -17.60-133.68, P = 0.13), calcium levels (MD -0.07, 95% CI -0.17-0.04, P = 0.21), phosphorus levels (MD 0.21, 95% CI -0.18-0.61, P = 0.29), or hoarseness (OR 0.53, 95% CI 0.24-1.16, P = 0.11) between the two surgical methods. Compared with PTX, thermal ablation reduced the risk of hypocalcaemia (OR 0.23, 95% CI 0.11-0.47, P < 0.01). However, thermal ablation increased the risk of SHPT persistence and/or recurrence compared with PTX (OR 4.24, 95% CI 1.44-15.76, P = 0.03).
CONCLUSION
Thermal ablation and PTX were effective surgical approaches for SHTP. Thermal ablation reduced the risk of hypocalcaemia and increased the risk of SHPT persistence and recurrence. More large multicentre randomized controlled trials are necessary to confirm the conclusions.
Topics: Ablation Techniques; Adult; Aged; Cohort Studies; Humans; Hyperparathyroidism, Secondary; Hypocalcemia; Middle Aged; Parathyroid Hormone; Parathyroidectomy
PubMed: 31404676
DOI: 10.1016/j.ijsu.2019.08.004 -
Surgery Nov 2021Few studies assess use of parathyroidectomy among older adults with symptomatic primary hyperparathyroidism. Our objective was to determine national usage and...
BACKGROUND
Few studies assess use of parathyroidectomy among older adults with symptomatic primary hyperparathyroidism. Our objective was to determine national usage and disparities in parathyroidectomy for symptomatic primary hyperparathyroidism among insured older adults.
METHODS
We identified older adult patients with symptomatic primary hyperparathyroidism using Medicare claims (2006-2017). Primary study variables were race/ethnicity, rurality, and zip-code socioeconomic status. We calculated cumulative incidence of parathyroidectomy and used multivariable Cox proportional hazards regression models to assess the adjusted association of our study variables with parathyroidectomy.
RESULTS
We included 94,803 patients. The median age at primary hyperparathyroidism diagnosis was 76 years (interquartile range 71-82). The majority of patients were female (72%), non-Hispanic White (82%), from metropolitan areas (82%), and had a Charlson Comorbidity score ≥3 (62%). Nine percent of patients (n = 8,251) underwent parathyroidectomy during follow-up. After adjustment, non-Hispanic Black patients, compared to non-Hispanic White (hazard ratio 0.80; 95% confidence interval 0.74, 0.87), and living in a low socioeconomic status neighborhood (low socioeconomic status vs highest socioeconomic status hazard ratio 0.89; 95% confidence interval 0.83, 0.95) were both associated with lower incidences of parathyroidectomy. Patients from non-metropolitan areas were more likely to undergo parathyroidectomy.
CONCLUSION
Parathyroidectomy is underused for symptomatic primary hyperparathyroidism in older adults. Quality improvement efforts, rooted in equitable care, should be undertaken to increase access to parathyroidectomy for this disease.
Topics: Aged; Aged, 80 and over; Cohort Studies; Ethnicity; Female; Healthcare Disparities; Humans; Hyperparathyroidism, Primary; Incidence; Male; Medicare; Parathyroidectomy; Retrospective Studies; Social Class; United States
PubMed: 34127301
DOI: 10.1016/j.surg.2021.05.026 -
Otolaryngology--head and Neck Surgery :... Mar 2019To examine opioid-prescribing patterns after endocrine surgery. To evaluate factors associated with postoperative pain and opioid use.
OBJECTIVES
To examine opioid-prescribing patterns after endocrine surgery. To evaluate factors associated with postoperative pain and opioid use.
STUDY DESIGN
Cross-sectional.
SETTING
Academic university health system.
SUBJECTS AND METHODS
The study sample included 209 patients who underwent total thyroidectomy, hemithyroidectomy, or parathyroidectomy by 4 surgeons between August 2015 and November 2017. Eighty-nine patients completed a phone survey about postoperative pain and opioid use. Prescription, demographic, and comorbidity data were collected retrospectively. Patient characteristics associated with opioid use, use of ≥10 opioid pills, and pain score were identified via chi-square, t test, analysis of variance, or Pearson correlation. Identified factors were further assessed with multivariable logistic and linear regression modeling.
RESULTS
The median numbers of opioid pills prescribed were 20 for total thyroidectomy, 25 for hemithyroidectomy, and 20 for parathyroidectomy, and the median numbers of pills used were 1.5, 2, and 0, respectively. Of 1947 total prescribed pills, 19.7% were reported to be taken. The number of pills meeting the opioid needs of 80% of these patients was 10. In multivariable analyses, older age was associated with lower odds of opioid use (odds ratio, 0.97; 95% CI, 0.94-0.999; P = .04) and lower pain scores (Pearson correlation coefficient, -0.05; 95% CI, -0.10 to 0.001, P = .04). Charlson Comorbidity Index score >5 was associated with use of ≥10 pills (odds ratio, 6.62; 95% CI, 1.60-27.50; P = .01).
CONCLUSION
Excess opioids are often prescribed for endocrine surgery. By using an ideal pill number and understanding predictors of postoperative pain, surgeons can more adequately treat pain and limit excess opioid prescriptions.
Topics: Adult; Analgesics, Opioid; Cross-Sectional Studies; Female; Humans; Length of Stay; Male; Middle Aged; Pain, Postoperative; Parathyroid Diseases; Parathyroidectomy; Practice Patterns, Physicians'; Thyroid Diseases; Thyroidectomy
PubMed: 30324865
DOI: 10.1177/0194599818797574