Total parathyroidectomy without autotransplantation is safe and effective for elderly patients with secondary hyperparathyroidism (SHPT) and a good alternative to total parathyroidectomy with autotransplantation, researchers reported online in Aging Clinical and Experimental Research.
To determine the optimal surgical approach in elderly SHPT patients, Andrea Polistena, MD, of the University of Perugia in Terni, Italy, and colleagues studied a retrospective series of 253 SHPT patients who underwent parathyroidectomy. The cohort included 218 patients aged less than 65 years (group A) and 35 patients older than 65 years (group B) at a single institution. In all cases, surgeons monitored intraoperative parathyroid hormone (PTH) levels.
Surgeons performed subtotal parathyroidectomy in 122 patients in group A and 7 patients in group B and total parathyroidectomy with autotransplantation in 15 patients in group A and none of the patients in group B. Surgeons performed total parathyroidectomy alone in 88 patients in group A and 28 patients in group B.
The investigators observed no significant difference in surgical complications between the 2 groups. Reoperation for persistent or recurrent SHPT was required for 19 patients in group A and none of the patients in the group B. Post-operative PTH and calcium/phosphorus values returned to normal or acceptable values in 92.4% of patients at 1 month. Nearly 90% of patients achieved adequate post-operative symptom control, with no significant differences among the surgical procedures, Dr Polistena and her colleagues reported.
1. Polistena A, Sanguinetti A, Lucchini R, et al. Surgical treatment of secondary hyperparathyroidism is elderly patients: an institutional experience. Aging Clin Exp Res. 2016; published online ahead of print.