Successful minimally invasive surgery for primary hyperparathyroidism: influence of preoperative imaging and intraoperative parathyroid hormone levels.

Détails

ID Serval
serval:BIB_8FCF446A1FF3
Type
Article: article d'un périodique ou d'un magazine.
Collection
Publications
Titre
Successful minimally invasive surgery for primary hyperparathyroidism: influence of preoperative imaging and intraoperative parathyroid hormone levels.
Périodique
Langenbeck's archives of surgery
Auteur(s)
Joliat G.R., Demartines N., Portmann L., Boubaker A., Matter M.
ISSN
1435-2451 (Electronic)
ISSN-L
1435-2443
Statut éditorial
Publié
Date de publication
12/2015
Peer-reviewed
Oui
Volume
400
Numéro
8
Pages
937-944
Langue
anglais
Notes
Publication types: Journal Article
Publication Status: ppublish
Résumé
Adenoma is the main parathyroid disorder leading to primary hyperparathyroidism (PHP). Minimally invasive parathyroidectomy (MIP) is recognized as a valid procedure for adenoma-related PHP. It requires precise preoperative localization combining Tc-99m-MIBI (methoxy-isobutyl-isonitrile) scintigraphy and single-photon emission computed tomography (SPECT) with x-ray computed tomography (CT) and intraoperative confirmation of successful excision by change in intact parathormone (iPTH) levels. The study aim was to assess the surgery success in relation to these two parameters.
All patients operated on for PHP from 2005 to mid-2014 at our institution were retrospectively reviewed. MIP was performed in case of precise preoperative adenoma localization on scintigraphy, absence of past cervical surgery, and absence of concomitant thyroid resection necessity. In these patients, iPTH levels were monitored intraoperatively. Confirmation criteria for iPTH values were a return to normal level or a decrease >50 % of basal iPTH level.
There were 197 PHP operations during the study period: 118 MIP and 79 bilateral neck explorations (BNEs). The MIP success rate was 95 % (112/118) with a preoperative MIBI scan ± CT accurate in 94 % (111/118) of the patients and with correct iPTH in 90 % (106/118) of the cases. Among the 12 iPTH levels that did not meet the confirmation criteria, 10 returned to normal range by postoperative day 2. Treatment failure appeared in three patients (one BNE, two MIPs).
Tc-99m-MIBI dual-phase scintigraphy with SPECT/CT is the key examination for functional and morphological parathyroid adenoma localization. If preoperative scintigraphy is obvious and intraoperative assessment is clear, one could possibly safely omit iPTH, as it may lead to unnecessary BNE in primary PHP.

Mots-clé
Adenoma/complications, Adenoma/surgery, Adult, Aged, Aged, 80 and over, Female, Humans, Hyperparathyroidism, Primary/etiology, Hyperparathyroidism, Primary/radiography, Hyperparathyroidism, Primary/radionuclide imaging, Hyperparathyroidism, Primary/surgery, Male, Middle Aged, Minimally Invasive Surgical Procedures/methods, Multimodal Imaging, Parathyroid Hormone/blood, Parathyroid Neoplasms/complications, Parathyroid Neoplasms/surgery, Parathyroidectomy/methods, Radiopharmaceuticals, Retrospective Studies, Technetium Tc 99m Sestamibi, Tomography, Emission-Computed, Single-Photon, Tomography, X-Ray Computed, Treatment Failure, Treatment Outcome
Pubmed
Création de la notice
29/03/2016 18:26
Dernière modification de la notice
03/03/2018 19:23
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