Subtotal Parathyroidectomy Versus Total Parathyroidectomy with Autotransplantation for Patients with Multiple Endocrine Neoplasia 1 and Primary Hyperparathyroidism
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.
KeywordsMultiple endocrine neoplasia type 1 Parathyroidectomy Parathyroid transplantation Persistent and recurrent hyperparathyroidism Postoperative hypoparathyroidism
- 8.Nilubol N, Weisbrod AB, Weinstein LS, Simonds WF, Jensen RT, Phan GQ, et al. Utility of intraoperative parathyroid hormone monitoring in patients with multiple endocrine neoplasia type 1-associated primary hyperparathyroidism undergoing initial parathyroidectomy. World J Surg. 2013;37(8):1966–72.CrossRefPubMedGoogle Scholar
- 24.Dotzenrath C, Cupisti K, Goretzki PE, Yang Q, Simon D, Ohmann C, et al. Long-term biochemical results after operative treatment of primary hyperparathyroidism associated with multiple endocrine neoplasia types I and IIa: is a more or less extended operation essential? Eur J Surg. 2001;167(3):173–8.CrossRefPubMedGoogle Scholar
- 25.Goudet P, Cougard P, Verges B, Murat A, Carnaille B, Calender A, et al. Hyperparathyroidism in multiple endocrine neoplasia type I: surgical trends and results of a 256-patient series from Groupe D’etude des Neoplasies Endocriniennes Multiples Study Group. World J Surg. 2001;25(7):886–90.CrossRefPubMedGoogle Scholar
- 29.Norton JA, Venzon DJ, Berna MJ, Alexander HR, Fraker DL, Libutti SK, et al. Prospective study of surgery for primary hyperparathyroidism (HPT) in multiple endocrine neoplasia-type 1 and Zollinger-Ellison syndrome: long-term outcome of a more virulent form of HPT. Ann Surg. 2008;247(3):501–10.CrossRefPubMedPubMedCentralGoogle Scholar
- 32.Pieterman CR, van Hulsteijn LT, den Heijer M, van der Luijt RB, Bonenkamp JJ, Hermus AR, et al. Primary hyperparathyroidism in MEN1 patients: a cohort study with longterm follow-up on preferred surgical procedure and the relation with genotype. Ann Surg. 2012;255(6):1171–8.CrossRefPubMedGoogle Scholar