AI Article Synopsis
- The study focused on reoperations for persistent or recurrent parathyroid adenomas, examining outcomes from 1996 to 2008 compared to earlier experiences from 1982 to 1995.
- A total of 237 patients underwent reoperation, with long-term hypercalcemia resolution achieved in 92%, and imaging techniques like sestamibi scanning were notably effective.
- Despite a slight increase in nerve injury rates, the study highlighted a shift towards more reliance on non-invasive imaging methods, leading to fewer invasive procedures for localization prior to surgery.
Article Abstract
Background: We reviewed reoperations for persistent or recurrent sporadic parathyroid adenoma to evaluate and compare our current results and outcomes to our previous experience.
Methods: From 1996 to 2008, 237 patients with persistent or recurrent hyperparathyroidism after failed operation underwent reoperation. Patients were re-explored with the assistance of non-invasive and sometimes invasive imaging.
Results: A missed adenoma was suspected pre-operatively in 163 patients. Reoperation resulted in long-term resolution of hypercalcemia in 92%. Adenomas were in entopic locations in 32%; the most frequent ectopic location was the thymus (20%). Sestamibi scanning and ultrasonography were the most successful non-invasive imaging studies (96% positive predictive value (PPV) and 84% PPV respectively). Forty-four percent of patients had a reoperation based solely on non-invasive imaging. Of the invasive procedures performed, arteriography resulted in the best localization (92% PPV). Permanent recurrent laryngeal nerve injury occurred in 1.8%.
Conclusion: Compared to our prior experience (1982-1995), outcomes remained similar (92% resolution of hypercalcemia and 1.8% recurrent nerve injury currently versus 96% and 1.3% previously). Fewer patients received invasive studies for pre-operative localization (56% vs 73%, respectively). The decreased use of invasive imaging is due to technical improvements and greater confidence in the combination of ultrasonography and sestamibi scanning.
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| http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3467310 | PMC |
| http://dx.doi.org/10.1016/j.surg.2009.09.015 | DOI Listing |
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