Outcomes of Total Parathyroidectomy with Autotransplantation versus Subtotal Parathyroidectomy with Routine Addition of Thymectomy to both Groups: Single Center Experience of Secondary Hyperparathyroidism

Abstract

Background:Secondary hyperparathyroidism is a common acquired disorder seenin chronic renalfailure. It mayresult in potentially seri-ouscomplications including metabolic bonediseases, severe athero-sclerosis andundesirable cardiovascular events. Parathyroidectomy is required in about 20%ofpatients after3-10years ofdialysis and in up to 40% after 20 years. Aims:Theaimof thecurrent study wasto evaluate theshort-term and long-term outcomes of patients withsecondary hyperparathyroidism whohadundergone totalparathyroidectomy withautotransplantation andthymectomy or subtotal parathyroidectomy withthymectomy by the same surgical team during the study period. Study Design: Retrospective comparative study.Methods:Clinical dataof50patients whounderwent parathyroid surgery forsecondary hyperparathyroidism between 2003 and2011 were reviewed retrospectively. Patients were divided intotwosub-groups oftotalparathyroidectomy withautotransplantation orsub-totalparathyroidectomy. Thymectomy wasroutinely performed for bothgroups. Short termoutcome parameters included intact parathy-roidhormone, ionized calcium andalkaline phosphatase levels. Bone pain, bonefractures, persistent orrecurrent disease wereincluded in long term outcome parameters.Results:Themean duration ofdialysis waseight years. Themean ionized calcium levels dropped significantly in thetotalparathyroid-ectomy withautotransplantation group (p=0.016). Noserious post-operative complications were observed. Postoperative intravenous calcium supplementation wasrequired infourpatients inthetotal parathyroidectomy withautotransplantation group (total PTX+AT) andin three patients in thesubtotal parathyroidectomy group (subto-talPTX). Postoperatively, allpatients received oralcalcium carbonate andcalcitriol. Thelength of average hospital staywas5 (3-10) days. Including ninepatients whounderwent successful renal transplanta-tionpre-operative bone symptoms, hypercalcemia, hyperphosphate-mia,andanincreased alkaline phosphatase levels wereimproved or resolved in allpatients. After a mean follow-up of65months, three patients (6%) had persistent and one (2%) had recurrent disease.Conclusion:Total parathroidectomy with autotransplantation is a beneficial andsafesurgical procedure forpatients onchronic di-alysis withotherwise uncontrollable secondary hyperparathroidism andevenin patients whohaveundergone renal transplantation after parathyroidectomy. Careful cervical exploration androutine thymec-tomy should beconsidered as a routine partof thesurgical approach regardless of the preferred technique