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Surgical Management of Primary Hyperparathyroidism in the Era of Focused Parathyroidectomy: A Study in Tertiary Referral Centre of North India

BACKGROUND: Despite the benefits of focused parathyroidectomy (FPTx), few studies have questioned its durability with lower long-term cure rates than bilateral or conventional parathyroidectomy (CPTx). The objective of this study is to bring out the information on the type of surgical management ver...

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Autores principales: Yadav, Sanjay K., Mishra, Saroj K., Mishra, Anjali, Mayilvagnan, Sabaretnam, Chand, Gyan, Agarwal, Gaurav, Agarwal, Amit, Verma, Ashok K.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Wolters Kluwer - Medknow 2019
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6844166/
https://www.ncbi.nlm.nih.gov/pubmed/31741908
http://dx.doi.org/10.4103/ijem.IJEM_255_19
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author Yadav, Sanjay K.
Mishra, Saroj K.
Mishra, Anjali
Mayilvagnan, Sabaretnam
Chand, Gyan
Agarwal, Gaurav
Agarwal, Amit
Verma, Ashok K.
author_facet Yadav, Sanjay K.
Mishra, Saroj K.
Mishra, Anjali
Mayilvagnan, Sabaretnam
Chand, Gyan
Agarwal, Gaurav
Agarwal, Amit
Verma, Ashok K.
author_sort Yadav, Sanjay K.
collection PubMed
description BACKGROUND: Despite the benefits of focused parathyroidectomy (FPTx), few studies have questioned its durability with lower long-term cure rates than bilateral or conventional parathyroidectomy (CPTx). The objective of this study is to bring out the information on the type of surgical management versus cure rate, recurrence, and role of intra-operative parathyroid hormone (IOPTH) level monitoring of PHPT patients. MATERIAL AND METHODS: This was a retrospective study of all PHPT patients treated at our center based on operative approach (CPTx vs FPTx) or use of IOPTH. Treatment failure was divided into persistent or recurrent disease, based on documentation of hypercalcemia in combination with an inappropriate PTH within 6 months or more of surgery, respectively. RESULTS: Overall, 50.78% patients underwent CPTx and 49.32% FPTx. 29 FPTx were converted to CPTx. Intention to treat analysis between CPTx and FPTx showed that the persistence rate was not statistically different at 2.54% and 4%, respectively (P = 0.98). Furthermore, when the persistence rate was scrutinized by a treatment received (TR) instead of ITT analysis, the persistence rate was higher for the patients who underwent TR-CPTX than for the patients subjected to TR-FPTX (3.22% vs 1.08%) but not significant statistically. We further analyzed the outcome of FPTx with IOPTH (n = 213) and FPTx without IOPTH (n = 28). The outcome did not differ between two groups statistically. CONCLUSION: FPTx yields a similar success rate as compared to CPTx even in symptomatic PHPT patients and can be performed safely even without intra-opeartive adjunct IOPTH in selected patients.
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spelling pubmed-68441662019-11-18 Surgical Management of Primary Hyperparathyroidism in the Era of Focused Parathyroidectomy: A Study in Tertiary Referral Centre of North India Yadav, Sanjay K. Mishra, Saroj K. Mishra, Anjali Mayilvagnan, Sabaretnam Chand, Gyan Agarwal, Gaurav Agarwal, Amit Verma, Ashok K. Indian J Endocrinol Metab Original Article BACKGROUND: Despite the benefits of focused parathyroidectomy (FPTx), few studies have questioned its durability with lower long-term cure rates than bilateral or conventional parathyroidectomy (CPTx). The objective of this study is to bring out the information on the type of surgical management versus cure rate, recurrence, and role of intra-operative parathyroid hormone (IOPTH) level monitoring of PHPT patients. MATERIAL AND METHODS: This was a retrospective study of all PHPT patients treated at our center based on operative approach (CPTx vs FPTx) or use of IOPTH. Treatment failure was divided into persistent or recurrent disease, based on documentation of hypercalcemia in combination with an inappropriate PTH within 6 months or more of surgery, respectively. RESULTS: Overall, 50.78% patients underwent CPTx and 49.32% FPTx. 29 FPTx were converted to CPTx. Intention to treat analysis between CPTx and FPTx showed that the persistence rate was not statistically different at 2.54% and 4%, respectively (P = 0.98). Furthermore, when the persistence rate was scrutinized by a treatment received (TR) instead of ITT analysis, the persistence rate was higher for the patients who underwent TR-CPTX than for the patients subjected to TR-FPTX (3.22% vs 1.08%) but not significant statistically. We further analyzed the outcome of FPTx with IOPTH (n = 213) and FPTx without IOPTH (n = 28). The outcome did not differ between two groups statistically. CONCLUSION: FPTx yields a similar success rate as compared to CPTx even in symptomatic PHPT patients and can be performed safely even without intra-opeartive adjunct IOPTH in selected patients. Wolters Kluwer - Medknow 2019 /pmc/articles/PMC6844166/ /pubmed/31741908 http://dx.doi.org/10.4103/ijem.IJEM_255_19 Text en Copyright: © 2019 Indian Journal of Endocrinology and Metabolism http://creativecommons.org/licenses/by-nc-sa/4.0 This is an open access journal, and articles are distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 License, which allows others to remix, tweak, and build upon the work non-commercially, as long as appropriate credit is given and the new creations are licensed under the identical terms.
spellingShingle Original Article
Yadav, Sanjay K.
Mishra, Saroj K.
Mishra, Anjali
Mayilvagnan, Sabaretnam
Chand, Gyan
Agarwal, Gaurav
Agarwal, Amit
Verma, Ashok K.
Surgical Management of Primary Hyperparathyroidism in the Era of Focused Parathyroidectomy: A Study in Tertiary Referral Centre of North India
title Surgical Management of Primary Hyperparathyroidism in the Era of Focused Parathyroidectomy: A Study in Tertiary Referral Centre of North India
title_full Surgical Management of Primary Hyperparathyroidism in the Era of Focused Parathyroidectomy: A Study in Tertiary Referral Centre of North India
title_fullStr Surgical Management of Primary Hyperparathyroidism in the Era of Focused Parathyroidectomy: A Study in Tertiary Referral Centre of North India
title_full_unstemmed Surgical Management of Primary Hyperparathyroidism in the Era of Focused Parathyroidectomy: A Study in Tertiary Referral Centre of North India
title_short Surgical Management of Primary Hyperparathyroidism in the Era of Focused Parathyroidectomy: A Study in Tertiary Referral Centre of North India
title_sort surgical management of primary hyperparathyroidism in the era of focused parathyroidectomy: a study in tertiary referral centre of north india
topic Original Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6844166/
https://www.ncbi.nlm.nih.gov/pubmed/31741908
http://dx.doi.org/10.4103/ijem.IJEM_255_19
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