Long-term cure of primary hyperparathyroidism after scan directed parathyroidectomy

Abstract

Abstract Background The advent of sestamibi scintigraphy led to an enthusiastic acceptance of minimally invasive parathyroidectomy (MIP). Recently, doubts have been raised about the efficacy of limited neck exploration and some surgeons proposed bilateral neck exploration to be (once again) the gold standard operation for primary hyperparathyroidism. Methods A departmental database was used to identify patients who had MIP after concordant dual localisation. Long-term follow-up data was obtained to ascertain any further treatment for recurrent disease and confirm most recent biochemical status. Patients with negative localisation scans and those with familial disease were excluded. Results Between June 2001 – August 2014 a total of 404 patients (108M:296F, median age 63 years, range 17–90 years) underwent MIP and had normalisation of calcium in first 6 weeks after the operation. Data were missing in 14 patients therefore data on 390 patients was analysed. During follow-up, 375 patients remained normocalcaemic (2.36mmol/L IQR: 2.29–2.44 mmol/L) at a median 75 months (IQR: 20–118months). Only 15 (3.85%) patients had biochemical evidence of recurrent hypercalcaemia (2.70mmol/L, IQR: 2.63–2.75 mmol/L) at 92 months (IQR: 6–196 months) after initial operation. Of these, 5 (1.28%) patients underwent a second parathyroid procedure. Conclusion Recurrence after scan-directed unilateral neck exploration occurred in 4% of patients after a long disease-free interval. Only one patient had recurrent disease within 1 year of primary surgery. Bilateral neck exploration at the time of initial operation, in this selected cohort, is unlikely to had uncovered multi-gland disease and prevent disease recurrence. Focused parathyroidectomy in patients with convincing localisation studies should continue.