A study on the causes of operative failures after microwave ablation for primary hyperparathyroidism

Wei Ying,Peng Li-Li,Yu Ming-An,Cao Xiao-Jing,Zhao Zhen-Long,Li Yan

doi:10.1007/s00330-021-07761-9

Abstract

ObjectiveTo summarize the occurrence of operative failures after microwave ablation (MWA) in patients with primary hyperparathyroidism (pHPT), analyze the possible reasons, and explore strategies for preventing and managing these situations.MethodsThis retrospective study reviewed 91 pHPT patients who underwent MWA from April 2015 to November 2019. A cure was defined as the reestablishment of normal calcium homeostasis lasting a minimum of 6 months. An operative failure was defined as a failure to normalize serum intact parathyroid hormone (iPTH) and/or calcium levels at 6 months or longer. Patients who encountered operative failures were compared with patients who were successfully cured.ResultsEighty-eight pHPT patients, consisting of 29 men and 59 women, were finally enrolled. The median follow-up duration was 15.9 months (IQR, 6.1–31.5 months). Seventy-eight patients (78/88, 88.6%) were cured. Ten (10/88, 11.4%) patients experienced operative failure, including 9 persistent pHPT (10.2%) and 1 (1.1%) recurrent pHPT. Small parathyroid nodules (maximum diameter < 0.6 cm) and incomplete ablation were the two key factors leading to operative failure. Of the 9 patients with a maximum nodule diameter less than 0.6 cm, 77.8% (7/9) of them encountered operative failure.ConclusionOperative failure occurred in 11.4% of the pHPT patients who underwent MWA. The possibility of operative failure was increased when the maximum diameter of parathyroid nodule was less than 0.6 cm. Complete ablation could help avoid operative failure.Key Points• Failed to ablate the target lesion and incomplete ablation were the key factors attributed to operative failures.• When the maximum diameter of the parathyroid nodules is less than 0.6 cm, the possibility of operative failure was higher.

Highlights

Primary hyperparathyroidism is a common endocrine disorder, with a prevalence of 0.1–0.4% [1]
Failed to ablate the target lesion and incomplete ablation were the key factors attributed to operative failures
When the maximum diameter of the parathyroid nodules is less than 0.6 cm, the possibility of operative failure was higher

Summary

Introduction

Primary hyperparathyroidism (pHPT) is a common endocrine disorder, with a prevalence of 0.1–0.4% [1]. It is generally characterized by hypercalcemia and elevated parathyroid hormone (PTH) levels [2]. 20% of pHPT patients are asymptomatic when discovered; the disease has the potential to become symptomatic. The common clinical manifestations of pHPT include bone loss, kidney stones, and neurocognitive impairment [1,2,3,4]. After more than a decade of clinical application, ultrasound-guided thermal ablation has been demonstrated to be effective in inactivating parathyroid nodules and normalizing serum PTH and calcium

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Discussion

Conclusion