Focused Versus Bilateral Parathyroid Exploration for Primary Hyperparathyroidism: A Systematic Review and Meta-analysis.

Abstract

Focused exploration (FE) and bilateral parathyroid exploration (BE) are the standard surgical options for patients with primary hyperparathyroidism. However, the relative risk of recurrence, persistence, overall failure, reoperation, and any complications associated with either surgical approach is unclear. This study compared the outcomes and complication rates after FE and BE for patients with primary hyperparathyroidism. PubMed and Embase were searched for studies comparing these outcomes between FE and BE. A meta-analysis was performed using RevMan 5.3 software. Published data were pooled using the DerSimonian random-effect model, and results were presented as odds ratio (OR) or mean difference with 95% confidence interval (CI). A total of 12,743 patients from 19 studies were included in this meta-analysis. In comparison with BE, the FE arm had comparable rates of recurrence (OR1.08; 95% CI 0.59-2.00; p=0.80; n=9 studies), persistence (OR0.89; 95% CI 0.58-1.35; p=0.58; n=13), overall failure (OR0.88; 95% CI 0.58-1.34; p=0.56; n=13), and reoperation (OR1.05; 95% CI 0.25-4.32; p=0.95, n=4). The operative time was significantly shorter (mean difference=-39.86; 95% CI -53.05 to -26.84; p<0.01, n=9), with a lower overall complication rate in the FE arm (OR 0.35; 95% CI 0.15-0.84; p=0.02; n=12). The latter was attributed predominantly to a lower risk of transient hypocalcemia (OR 0.36; 95% CI 0.14-0.90; p=0.03; n=9). There was a significant heterogeneity among these studies for all outcomes except for disease recurrence. Compared with BE, FE has similar recurrence, persistence, and reoperation rates but significantly lower overall complication rates and shorter operative time.