Abstract
In a randomized study subtotal parathyroidectomy (sPTX) was compared with total parathyroidectomy and autotransplantation of fresh tissue (PTX+AT) in 40 patients with severe secondary hyperparathyroidism (HPT). After surgery both groups were followed at 19±6 months (PTX +AT) and 19±7 months (sPTX) and at 43±9 months (PTX+AT) and 40±7 months (sPTX). There were 17 patients alive in each group at the time of the second follow-up. After sPTX, 2 patients required re-operation because of recurrent disease originating from the remaining parathyroid gland in the neck and another 2 patients were hypercalcemic at follow-up. After PTX + AT both serum calcium and alkaline phosphatase normalized significantly more often (p <0.03) than after sPTX. Re-operations were not required in this group. Radiological signs also improved significantly more after PTX+AT, as did clinical signs like pruritus (p < 0.005) and muscle weakness (p <0.04). These results and the fact that in recurrent disease a re-operation at the autograft in the forearm is simpler than a re-operation in the neck, lead to the recommendation that PTX+ AT should be considered as the method of choice in the surgical treatment of secondary HPT.
Résumé
Dans une étude randomisée, la parathyroÏdectomie subtotale (sPTX) a été comparée à la parathyroÏdectomie totale avec autotransplantation (PTX + AT) chez 40 patients ayant une hyperparathyroÏdie secondaire sévère (HPT). Après l'operation, les deux groupes de patients one été revus deux fois: à 19 ± 6 et à 43 ± 9 mois pour le groupe PTX + AT, et à 19 ± 7 et à 40 ± 7 mois pour le groupe sPTX. Dix-sept patients étaient en vie dans chaque groupe à la deuxième visite de contrÔle. Après sPTX, deux patients ont du Être réopérés en raison de tissu parathyroÏden résiduel; deux autres patients sont restés hypercalémiques. Après PTX + AT, la calcémie et le taux de phosphatases alcalines se sont normalisés plus souvent(P < 0.03) qu'après sPTX. Aucune réopération n'a été nécessaire dans le group PTX + AT. De mÊme, les signes radiologiques, les signes cliniques tels le prurit (p<0.005) et la faiblesse musculaire (p< 0.04) se sont améliorés plus souvent de faÇon significative dans le groupe PTX + AT. Ces résultats et le fait que lors des récidives, une autogreffe à l'avant-bras est plus simple qu'une réexploration cervicale, nous amène à préconiser la PTX + AT comme méthode de choix dans le traitement chirurgical de l'HPT.
Resumen
En un estudio randomizado se compararon la paratiriodectomía subtotal (sPTX) con la paratiroidectomía total con autotrasplante de tejido fresco (PTX + AT) en 40 pacientes con hiperparatiroidismo secundario severo (HPT). Ambos grupos fueron valorados dos veces después de la cirugía; a los 19±6 meses (PTX + AT) y 19±7 meses (sPTX) y a los 43±9 meses (PTX + AT) y los 40±7 meses (s(PTX). Se encontraron 17 pacientes vivos en cada grupo en el momenta de la segunda valoración. Después de sPTX 2 pacientes requirieron reoperación por enfermedad recurrente originada en la glándula paratiroides remanente en el cuello y otros 2 aparecieron hipercalcémicos. Después de PTX + AT tanto el calcio sérico como la fosfatasa alcalina se normalizaron significativamente con mayor frecuencia (p<0.03) que después de sPTX; no se requirieron reoperaciones en este grupo. Los signos radiológicos también mejoraron significativamente con mayor frecuencia después de PTX + AT, tal como lo hicieron signos clínicos tales como prurito (p<0.005) y debilidad muscular (p<0.04). Estas resultados, junto con el hecho de que en la enfermedad recurrente una reoperación sobre el autoinjerto en el antebrazo es más simple que una operación en el cuello, da lugar a recommendar que la PTX + AT es el método de escogencia en el manejo quirÚrgico del sHPT.
Article PDF
Similar content being viewed by others
Avoid common mistakes on your manuscript.
References
Rothmund, M., Wagner, P.K.: Total parathyroidectomy and autotransplantation of parathyroid tissue for renal hyperparathyroidism. Ann. Surg.197:7, 1983
Stanbury, S.W., Lumb, G.A., Nicholson, W.F.: Elective subtotal parathyroidectomy for renal hyperparathyroidism. Lancet1:793, 1960
Alveryd, A.: Parathyroid glands in thyroid surgery. Acta Chir. Scand. Suppl.389:1, 1968
Rothmund, M.: Surgical treatment of secondary hyperparathyroidism: Indication, operative management and results. Prog. Surg.18:186, 1986
Albertson, D.A., Poole, G.V., Myers, R.T.: Subtotal parathyroidectomy versus total parathyroidectomy with autotransplantation for secondary hyperparathyroidism. Am. Surg.51:16, 1985
Cordell, L.J., Maxwell, J.G., Warden, G.D.: Parathyroidectomy in chronic renal failure. Am. J. Surg.138:769, 1979
Malmaeus, J., Akerström, G., Johansson, H., Ljunghall, S., Nilsson, P., Selking, ö.: Parathyroid surgery in chronic renal insufficiency: Subtotal parathyroidectomy versus total parathyroidectomy with autotransplantation to the forearm. Acta Chir. Scand.148:229, 1982
Tagaki, H., Tominaga, Y., Uchida, K., Yamada, N., Kawai, M., Kano, T., Morimoto, T.: Subtotal versus total parathyroidectomy with forearm autograft for secondary hyperparathyroidism in chronic renal failure. Ann. Surg.200:18, 1984
Wells, S.A. Jr., Ross, A.J., Dale, J.K., Gray, R.S.: Transplantation of the parathyroid glands: Current status. Surg. Clin. North Am.59:167, 1979
Diethelm, A.G., Edwards, R.P., Welchel, I.D.: The natural history and surgical treatment of hypercalcemia before and after renal transplantation. Surg. Gynecol. Obstet.154:481, 1982
Rothmund, M., Wagner, P.K.: Assessment of parathyroid graft function after autotransplantation of fresh and cryopreserved tissue. World J. Surg.8:527, 1984
Wagner, P.K., Rothmund, M.: Reoperationen bei persistierendem und rezldivierendem sekundärem Hyperparathyreoidismus. Chirurg58:543, 1987
Massry, S.G.: Role of parathyroid hormone in the pathogenesis of the uremic manifestations. Klin. Wschr.57:1085, 1979
Dubost, C., Kracht, M., Assens, P., Sarfari, E., Zingraff, J., Drüeke, T.: Reoperation for secondary hyperparathyroidism in hemodialysis patients. World J. Surg.10:654, 1986
Edis, A.J., Levitt, M.D.: Supernumerary parathyroid glands: Implications for the surgical treatment of secondary hyperparathyroidism. World J. Surg.11:398, 1987
Speisberg, F., Oettinger, W., Marschner, I., Wood, W.G.: Behandlung des Hyperparathyreoidismus; simultane autologe Epithelkörperchen-Transplantation. Münch. med. Wschr.122:873, 1980
Thompson, B.W.: Results with parathyroidectomy and autotransplantation in patients with secondary HPT. Arch. Surg.115:384, 1980
Diaz-Buxo, J.A., Geissinger, W.T., Walker, P.J., Chandler, S.T., Farmer, C.D., Holt, K.L., Wolfe, P.: Total parathyroidectomy and autotransplantation. Clin. Nephrol.16:276, 1981
Diethelm, A.G., Adams, P.L., Murad, T.M., Daniel, W.W., Whelchel, J.D., Rutsky, E.A., Rostand, S.G.: Treatment of secondary hyperparathyroidism in patients with chronic renal failure by total parathyroidectomy and parathyroid autograft. Ann. Surg.193:777, 1981
Max, M.H., Flint, B.M., Richardson, J.D., Ferris, F.Z., Nagar, D.: Total parathyroidectomy and parathyroid autotransplantation in patients with chronic renal failure. Surg. Gynecol. Obstet.153:177, 1981
Klempa, I., Röttger, P., Schneider, M., Frei, U., Koch, K.M.: Transplantathyperparathyreoidismus—tumorähnliches Wachstum und autonome Funktion menschlicher Autotransplante von hyperplastischen Epithelkörperchen. Langenbecks Arch. Chir.356:191, 1982
Welsh, C.L., Taylor, G.W., Cattell, W.R., Baker, L.R.I.: Parathyroid surgery in chronic renal failure: Subtotal parathyroidectomy or autotransplantation? Br. J. Surg.71:591, 1984
Kinnaert, P., Vanherweghem, J.L., Fuss, M., Schoutens, A., Bergmann, P., Dratwa, M., van Geertruyden, J.: Total parathyroidectomy and parathyroid autograft for renal osteodystrophy: Analysis of the cause of failure. World J. Surg.9:500, 1985
McCarron, D.A., Lenfesty, B., Vetto, M., Barry, J., Bennett, W.M.: Total parathyroidectomy for posttransplantation hyperparathyroidism. Transplantation40:266, 1985
White, K.S., Wilkinson, C.A., Nixon, W.P., Almkuist II, R.D.: Total parathyroidectomy and forearm autotransplantation for chronic renal failure. South. Med. J.79:844, 1986
Korzets, Z., Magen, H., Kraus, L., Bernheim, J.: Total parathyroidectomy with autotransplantation in haemodialysed patients with secondary hyperparathyroidism: Should it be abandoned? Nephrol. Dial. Transplant.2:341, 1987
Alexander, P.T., Schumann, E.S., Vetto, M., Gross, G.F., Hayes, J.F., Standage, B.A.: Repeat parathyroid operation associated with renal disease. Am. J. Surg.155:686, 1988
Niederle, B., Hörandner, H., Roka, R., Woloszczuk, W.: Parathyreoidektomie und Autotransplantation beim renalen Hyperparathyreoidismus. Chirurg60:665, 1989
Henry, J.F.R., Denizot, A., Audiffret, J., France, G.: Results of reoperations for persistent or recurrent secondary hyperparathyroidism in hemodialysis patients. World J. Surg.14:303, 1990
Hognestad, J., Flatmark, A.: Hyperparathyroidism in uremia and after kidney transplanation. Scand. J. Urol. Nephrol. Suppl.42: 137, 1977
Swanson, M.R., Biggers, J.A. Remmers, A.R., Sarles, H.E., Nelson, R.M., Fish, J.C.: Results of parathyroidectomy for autonomous hyperparathyroidism. Arch. Intern. Med.139:989, 1979
Blake, D.P., O'Brien, T.J., Smith, C.L., Andersen, R.C., Hitchcock, C.R.: Surgical treatment of renal hyperparathyroidism. Surg. Gynecol. Obstet.157:325, 1983
Delmonico, F.L., Wang, C.A., Rubin, N.T., Fang, L.S., Herrin, J.T., Cosimi, A.B.: Parathyroid surgery in patients with renal failure. Ann. Surg.200:644, 1984
Zdon, M.J., Iliopoulos, J.I., Thomas, J.H., Pierce, G.E., Hermreck, A.S., Friesen, S.R.: Subtotal parathyroidectomy for secondary hyperparathyroidism. Surgery96:1103, 1984
Neale, T.J., Watson, E.C.: Parathyroid surgery in chronic renal failure. N. Z. Med. J.98:939, 1985
Sitges-Serra, A., Caralsp-Riera, A.: Secondary hyperparathyroidism in uremic patients. Surg. Clin. North Am.67:360, 1987
Johnson, W.J., McCarthy, J.T., van Heerden, J.A., Sterioff, S., Grant, C.S., Kao, P.C.: Results of subtotal parathyroidectomy in hemodialysis patients. Am. J. Med.84:23, 1988
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
Rothmund, M., Wagner, P.K. & Schark, C. Subtotal parathyroidectomy versus total parathyroidectomy and autotransplantation in secondary hyperparathyroidism: A randomized trial. World J. Surg. 15, 745–750 (1991). https://doi.org/10.1007/BF01665309
Issue Date:
DOI: https://doi.org/10.1007/BF01665309