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Subtotal Parathyroidectomy Versus Total Parathyroidectomy with Autotransplantation for Patients with Multiple Endocrine Neoplasia 1 and Primary Hyperparathyroidism

  • Terry C. Lairmore
Chapter
First Online:
Part of the Difficult Decisions in Surgery: An Evidence-Based Approach book series (DDSURGERY)

Abstract

Hyperparathyroidism in patients with MEN 1 is characterized by multiple gland involvement. Two surgical approaches have been advocated in these patients: total parathyroidectomy with heterotopic autotransplantation of parathyroid tissue grafts into skeletal muscle (TP/AT), or subtotal (3 and ½ gland) parathyroidectomy (SP) leaving a vascularized remnant of parathyroid tissue in situ in the neck. Despite the potential advantages and disadvantages of these two commonly practiced operations, previous retrospective studies have demonstrated similar overall rates of recurrent HPT and permanent postoperative hypoparathyroidism in patients undergoing the two operative procedures. Although one of these approaches is often preferred by individual endocrine surgery centers of excellence, improved outcomes or a clear advantage for either operation has not been previously established. The cumulative evidence from prior retrospective studies and a single randomized controlled trail is presented, and recommendations are made based on the available data. The level of evidence and grade for the strength of these recommendations is provided.

Keywords

Multiple endocrine neoplasia type 1 Parathyroidectomy Parathyroid transplantation Persistent and recurrent hyperparathyroidism Postoperative hypoparathyroidism 
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Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Division of Surgical Oncology, Department of SurgeryBaylor Scott and White Health, Texas A&M University Health Science CenterTempleUSA

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