A recent systematic review and meta-analysis finds similar efficacy for total parathyroidectomy with and without autotransplantation.
Yanbing Zhou, MD, PhD, of Affiliated Hospital of Qingdao University in China, and collaborators reviewed 10 cohort studies and 1 randomized controlled trial published 1991 to 2016 comparing the procedures for refractory secondary hyperparathyroidism (SHPT). All included studies were judged “high quality.” In total, 275 patients underwent total parathyroidectomy (TPTx) and 833 TPTx with autotransplantation (TPTx + AT). During the procedures, all visible parathyroid glands were removed. For autotransplantation, most surgeons chose the brachioradialis muscle because the site allowed easier reoperation; alternate locations included the sternocleidomastoid muscle or tibialis anterior muscle.
In a paper published in Renal Failure (2017;39:678-687), the team reported no significant differences between groups in the prevalence of surgical complications (e.g., bleeding and hoarseness), all-cause mortality (9.8% TPTx vs 14.8% TPTx + AT), SHPT persistence, or symptomatic improvement (e.g., pruritus and bone pain).
TPTx, however, reduced the risk of SHPT recurrence significantly by 81% and reoperation due to recurrence or persistence by 54%, compared with TPTX + AT. The tradeoff was TPTx increased the risk of hypoparathyroidism by 2.6 times. The investigators found no cases of adynamic bone disease or hypocalcemia.
“Our meta-analysis suggests that tPTX and tPTX + AT are effective surgical approaches to the treatment of sHTP,” Dr Zhou and colleagues concluded.
The investigators encouraged clinicians to discuss the pros and cons of each procedure with patients during counseling.
Li C, Lv L, Wang H, et al. Total parathyroidectomy versus total parathyroidectomy with autotransplantation for secondary hyperparathyroidism: systematic review and meta-analysis. Ren Fail 2017 Nov;39(1):678-687. doi: 10.1080/0886022X.2017.1363779