Cem Kaan PARSAK, İsmail Cem ERAY, Gökhan SARITAŞ, Gülşah SEYDAOGLU, Orhan DEMİRCAN, Gürhan SAKMAN, Mustafa BALAL

Outcomes of Total Parathyroidectomy with Autotransplantation versus Subtotal Parathyroidectomy with Routine Addition of Thymectomy to both Groups: Single Center Experience of Secondary Hyperparathyroidism

Background:Secondary hyperparathyroidism is a common acquired disorder seenin chronic renalfailure. It mayresult in potentially seri-ouscomplications including metabolic bonediseases, severe athero-sclerosis andundesirable cardiovascular events. Parathyroidectomy is required in about 20%ofpatients after3-10years ofdialysis and in up to 40% after 20 years. Aims:Theaimof thecurrent study wasto evaluate theshort-term and long-term outcomes of patients withsecondary hyperparathyroidism whohadundergone totalparathyroidectomy withautotransplantation andthymectomy or subtotal parathyroidectomy withthymectomy by the same surgical team during the study period. Study Design: Retrospective comparative study.Methods:Clinical dataof50patients whounderwent parathyroid surgery forsecondary hyperparathyroidism between 2003 and2011 were reviewed retrospectively. Patients were divided intotwosub-groups oftotalparathyroidectomy withautotransplantation orsub-totalparathyroidectomy. Thymectomy wasroutinely performed for bothgroups. Short termoutcome parameters included intact parathy-roidhormone, ionized calcium andalkaline phosphatase levels. Bone pain, bonefractures, persistent orrecurrent disease wereincluded in long term outcome parameters.Results:Themean duration ofdialysis waseight years. Themean ionized calcium levels dropped significantly in thetotalparathyroid-ectomy withautotransplantation group (p=0.016). Noserious post-operative complications were observed. Postoperative intravenous calcium supplementation wasrequired infourpatients inthetotal parathyroidectomy withautotransplantation group (total PTX+AT) andin three patients in thesubtotal parathyroidectomy group (subto-talPTX). Postoperatively, allpatients received oralcalcium carbonate andcalcitriol. Thelength of average hospital staywas5 (3-10) days. Including ninepatients whounderwent successful renal transplanta-tionpre-operative bone symptoms, hypercalcemia, hyperphosphate-mia,andanincreased alkaline phosphatase levels wereimproved or resolved in allpatients. After a mean follow-up of65months, three patients (6%) had persistent and one (2%) had recurrent disease.Conclusion:Total parathroidectomy with autotransplantation is a beneficial andsafesurgical procedure forpatients onchronic di-alysis withotherwise uncontrollable secondary hyperparathroidism andevenin patients whohaveundergone renal transplantation after parathyroidectomy. Careful cervical exploration androutine thymec-tomy should beconsidered as a routine partof thesurgical approach regardless of the preferred technique

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