Parathyroid Cancer: A single centre experience of the Endocrine Surgical Care Group.

Abstract

Abstract Aim Parathyroid Cancer is a rare condition (<3% of Primary Hyperparathyroidism). Under staging/treatment can have disastrous consequences. Risk of local recurrence, distal metastases and death is as double of those treated appropriately. This study shows the experience of a single centre with the objective of demonstrating the importance of preoperative diagnosis, staging and initial treatment showing the difference and improved outcomes for patients appropriately treated applying the Schulte’s 3 + 3 rule. Methods Retrospective single centre review. The data consists of patients whom underwent oncological Parathyroidectomy between 2005 and 2020 at King’s College Hospital. SPSS software was used for analysis. Results 38 patients were included in the study: 10 patients underwent local excision; 28 underwent oncological resection (unilateral en-bloc resection of thyroid lobe, both parathyroids and level VI lymphadenectomy). Three patients who underwent local excision elsewhere had local recurrence and were referred to our centre for further treatment. One patient with pre-operative lung metastases, underwent oncological resection had also local recurrence and died after 12 years follow up. One patient with single lung met who underwent oncological resection and excision of lung met is free of disease after 10 years. Thirty-three patients are free of disease. Average pre-operative Calcium was 3.01nmol/L, PTH 287ng/L and size 36mm. Conclusion Under staging/treatment showed 12-fold increase in recurrence rates. The only observed recurrence in patients that underwent initial en-bloc resection was related to advance staging/distant metastasis. This highlights the importance of recognising pre-operative indicative factors for appropriate surgical planning, reducing risk of recurrence/death.