Total PTx Without Autotransplantation May Improve Outcomes
Meta-analysis reveals a lower risk of recurrence and persistence of SHPT when total parathyoidectomy is performed without transplanting parathyroid tissue.
Total parathyroidectomy (TPTx) without versus with autotransplantation is associated with a reduced risk of secondary hyperparathyroidism (SHPT) recurrence and persistence, a new meta-analysis suggests.
In the absence of sufficient randomized controlled trial (RCT) data directly comparing both forms of TPTx, Nian-Cun Qiu, MD, of the Second Military Medical University in Shanghai, and colleagues pooled data from 1283 patients in 9 cohort studies rated 5 or above on the Newcastle-Ottawa scale and 1 RCT, published on or before November 2016. Compared with TPTx with autotransplantation, TPTx alone is associated with 80%, 82%, and 83% lower odds of SHPT recurrence, recurrence or persistence, and reoperation due to recurrence or persistence, respectively, the investigators reported online in the International Journal of Surgery. The surgery was also shorter by 17.3 minutes, suggesting reduced trauma. The procedures also did not differ markedly with respect to symptom improvement, complications, calcium or vitamin requirements, and length of hospital stay. TPTx alone, however, was associated with 3-fold greater odds of hypoparathyroidism.
Limited data on adverse events showed that no patient developed enduring hypocalcemia or adynamic bone disease during 3 years of follow up.
TPTx without autotransplantation “may be a feasible alternative therapeutic option for the surgical treatment of refractory SHPT,” Dr Qui and colleagues concluded.
Limitations of the meta-analysis included variable samples sizes and diverse definitions of SHPT recurrence and persistence of the included studies.
Qiu NC, Zha SL, Liu ME, et al. To Assess the Effects of Parathyroidectomy (TPTX versus TPTX+AT) for Secondary Hyperparathyroidism in Chronic Renal Failure: A Meta-Analysis. Intl J Surg. doi: 10.1016/j.ijsu.2017.06.029