Surgery for Sporadic Primary Hyperparathyroidism: Evolution over the Last Twenty Years in a Monocentric Setting
Abstract
:Simple Summary
Abstract
1. Introduction
2. Materials and Methods
2.1. Preoperative Diagnostic Tests
2.2. Treatment
- -
- conventional: bilateral cervical exploration, visualization of all the parathyroid glands, and removal of the pathological one or ones.
- -
- open minimally invasive (MIP) or video-assisted minimally invasive (MIVAP): identification and focused removal of glands indicated as pathological. The video-assisted procedure has been gradually abandoned in the last ten years, not offering substantial advantages over the minimally invasive open one.
- -
- transoral approach was recently adopted, consisting of a totally endoscopic procedure through three accesses in the inferior oral vestibulum (TOEPVA: trans oral endoscopic parathyroidectomy vestibular approach) [7], by us modified by moving the central access into the submental dimple (H-TOEPSA: hybrid trans oral endoscopic parathyroidectomy submental approach) to ensure optimal cosmetic results.
2.3. Follow-Up
- -
- group A: patients operated adopting ioPTH assay;
- -
- group B: patients operated without ioPTH assay.
2.4. Statistics
3. Results
- Group A
- Group B
4. Discussion
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
References
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Group A (n = 65) IOPTH Group | Group B (n = 439) | p Value | |
---|---|---|---|
Baseline | |||
Gender (m/f%) | 20(30.9)/45 (69.2) | 93 (21.2)/346 (78.8) | - |
Mean age (m/f) | 61.4/63.9 | 57.1/60 | - |
Onset | |||
Asymptomatic (%) | 25 (38.4) | 261 (59.4) | 0.046 |
Symptomatic (%) | 37 (56.9) | 178 (40.6) | 0.033 |
Persistence (%) | 3 (4.6) | 0.956 | |
Preoperative imaging | |||
US (%) | 63 (97%) | 422 (96.2) | 0.220 |
Scintigraphy (%) | 62 (95.3) | 371 (84.5) | 0.034 |
US −/Scint. + (%) | 10/5 (50) | 90/42 (47) | 0.096 |
US +/ Scint. −(%) | 53/43 (79.2) | 332/340 (91.5) | 0.031 |
Preoperative blood tests | |||
PTH (pmol/L) (ref: 1.3–7.5) | 32.95 | 32.8 | 0.092 |
Calcium (mg/dL) (ref: 8.6–10.2) | 11.54 | 11.31 | 0.123 |
Phosphorus (mg/dL) (ref: 2.5–4.5) | 2.2 | 2.4 | 0.501 |
Calciuria (mg/24 h) (ref: 100–300) | 407.7 | 446.5 | 0.046 |
Phosphaturia (mg/24 h) (ref: 400–1300) | 794.8 | 763.3 | 0.087 |
Group A (n = 65) IOPTH Group | Group B (n = 439) | p Value | |
---|---|---|---|
Procedure | |||
Mininvasive (%) | 21 (32.8) MIP-MIVAP | 155 (34.4) MIP-H-TOEPSA | 0.077 |
Conventional (%) | 44 (67.2) | 288 (65.6) | 0.157 |
Mean operative time (min) | 112 | 38 | 0.022 |
Histopathology | |||
Unique adenoma (%) | 51 (78.5) | 390 (88.8) | 0.043 |
Double adenoma (%) | 6 (9.2) | 11 (2.5) | 0.030 |
Diffuse hyperplasia (%) | 4 (6.2) | 19 (4.3) | 0.167 |
Nonspecific tissue (%) | 4 (6.2) | 6 (1.3) | 0.041 |
Atypical adenoma (%) | - | 7 (1.5) | 0.023 |
Carcinoma (%) | - | 6 (1.3) | 0.045 |
Postoperative complications | 7 (10.8) | 41 (9.3) | 0.576 |
Outcomes | |||
Persistence (%) | 2 (3) | 6 (1.3) | 0.096 |
Remission (%) | 63 (97) | 433 (98.7) | 0.568 |
Follow-up | |||
Mean 6 h Ca/PTH (mg/dL; pmol/L) | 9.9/1.75 | 10.5/2.4 | 0.267 |
Mean 8–22 h Ca/PTH (mg/dL; pmol/L) | 8.9/4.3 | 8.9/3.5 | 0.654 |
Mean 1 month Ca/PTH (mg/dL; pmol/L) | 8.9/9.5 | 9/9.7 | 0.454 |
Costs (euro) | 1680 + 170 | 570 | 0.01 |
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Giudici, F.; Fortuna, L.; Russo, E.; Badii, B.; Coratti, F.; Staderini, F.; Morandi, A.; Sparano, C.; Petrone, L.; Cianchi, F.; et al. Surgery for Sporadic Primary Hyperparathyroidism: Evolution over the Last Twenty Years in a Monocentric Setting. Cancers 2023, 15, 2581. https://doi.org/10.3390/cancers15092581
Giudici F, Fortuna L, Russo E, Badii B, Coratti F, Staderini F, Morandi A, Sparano C, Petrone L, Cianchi F, et al. Surgery for Sporadic Primary Hyperparathyroidism: Evolution over the Last Twenty Years in a Monocentric Setting. Cancers. 2023; 15(9):2581. https://doi.org/10.3390/cancers15092581
Chicago/Turabian StyleGiudici, Francesco, Laura Fortuna, Edda Russo, Benedetta Badii, Francesco Coratti, Fabio Staderini, Alessio Morandi, Clotilde Sparano, Luisa Petrone, Fabio Cianchi, and et al. 2023. "Surgery for Sporadic Primary Hyperparathyroidism: Evolution over the Last Twenty Years in a Monocentric Setting" Cancers 15, no. 9: 2581. https://doi.org/10.3390/cancers15092581