Annals of Surgical Oncology

, Volume 24, Issue 7, pp 1924–1934 | Cite as

Focused Versus Bilateral Parathyroid Exploration for Primary Hyperparathyroidism: A Systematic Review and Meta-analysis

  • Marcel Jinih
  • Emer O’Connell
  • Donal P. O’Leary
  • Aaron Liew
  • Henry P. Redmond
Endocrine Tumors



Focused exploration (FE) and bilateral parathyroid exploration (BE) are the standard surgical options for patients with primary hyperparathyroidism. However, the relative risk of recurrence, persistence, overall failure, reoperation, and any complications associated with either surgical approach is unclear. This study compared the outcomes and complication rates after FE and BE for patients with primary hyperparathyroidism.


PubMed and Embase were searched for studies comparing these outcomes between FE and BE. A meta-analysis was performed using RevMan 5.3 software. Published data were pooled using the DerSimonian random-effect model, and results were presented as odds ratio (OR) or mean difference with 95% confidence interval (CI).


A total of 12,743 patients from 19 studies were included in this meta-analysis. In comparison with BE, the FE arm had comparable rates of recurrence (OR 1.08; 95% CI 0.59–2.00; p = 0.80; n = 9 studies), persistence (OR 0.89; 95% CI 0.58–1.35; p = 0.58; n = 13), overall failure (OR 0.88; 95% CI 0.58–1.34; p = 0.56; n = 13), and reoperation (OR 1.05; 95% CI 0.25–4.32; p = 0.95, n = 4). The operative time was significantly shorter (mean difference = −39.86; 95% CI −53.05 to −26.84; p < 0.01, n = 9), with a lower overall complication rate in the FE arm (OR  0.35; 95% CI 0.15–0.84; p = 0.02; n = 12). The latter was attributed predominantly to a lower risk of transient hypocalcemia (OR  0.36; 95% CI 0.14–0.90; p = 0.03; n = 9). There was a significant heterogeneity among these studies for all outcomes except for disease recurrence.


Compared with BE, FE has similar recurrence, persistence, and reoperation rates but significantly lower overall complication rates and shorter operative time.


Primary Hyperparathyroidism Preoperative Localization Persistence Rate Postoperative Hypocalcemia Single Adenoma 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.



The authors declare no conflict of interest.

Supplementary material

10434_2016_5694_MOESM1_ESM.docx (208 kb)
Supplementary material 1 (DOCX 207 kb)


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Copyright information

© Society of Surgical Oncology 2016

Authors and Affiliations

  • Marcel Jinih
    • 1
  • Emer O’Connell
    • 1
  • Donal P. O’Leary
    • 1
  • Aaron Liew
    • 2
    • 3
  • Henry P. Redmond
    • 1
  1. 1.Department of Academic SurgeryCork University Hospital (CUH)CorkIreland
  2. 2.National University of Ireland Galway (NUIG)Portiuncula University Hospital and Galway University Hospital, Saolta University Health Care GroupGalwayIreland
  3. 3.Institute of Cellular MedicineNewcastle UniversityNewcastle upon TyneUK

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