Difficult Decisions in Endocrine Surgery pp 163-178 | Cite as
Subtotal Parathyroidectomy Versus Total Parathyroidectomy with Autotransplantation for Patients with Multiple Endocrine Neoplasia 1 and Primary Hyperparathyroidism
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 hypoparathyroidismReferences
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