A Review of Parathyroid Surgery for Primary Hyperparathyroidism from the United Kingdom Registry of Endocrine and Thyroi
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ORIGINAL SCIENTIFIC REPORT
A Review of Parathyroid Surgery for Primary Hyperparathyroidism from the United Kingdom Registry of Endocrine and Thyroid Surgery (UKRETS) H. Ishii1
•
M. J. Stechman2 • J. C. Watkinson3 • S. Aspinall4 • D. S. Kim1
Accepted: 14 November 2020 Ó The Author(s) 2020
Abstract Background The United Kingdom Registry of Endocrine and Thyroid Surgeons is a national database holding details on [ 28,000 parathyroidectomies. Methods An extract (2004–2017) of the database was analysed to investigate the reported efficacy, safety and use of intra-operative surgical adjuncts in targeted parathyroidectomy (tPTx) and bilateral neck exploration (BNE) for adult, first-time primary hyperparathyroidism (PHPT). Results 50.9% of 21,738 cases underwent tPTx. Excellent short-term (median follow-up 35 days) post-operative normocalcaemia rates were reported overall (tPTx 96.6%, BNE 94.5%, p \ 0.05) and in image-positive cases (tPTx 96.7%, BNE 96%, p \ 0.05). Intra-operative PTH improved overall normocalcaemia rates (tPTx 97.8% vs 96.3%, BNE 95% vs 94.4%: both p \ 0.05). Intra-operative nerve monitoring reduced vocal cord (VC) dysfunction in image-positive tPTx, but not in BNE (97.8% vs 93.2%, p \ 0.05). Complications were higher following BNE (7.4% vs 3.8%, p \ 0.05), especially hypocalcaemia (5.3% vs 2%, p \ 0.05). There was no difference in rates of subjective dysphonia following tPTx or BNE (2.4% vs 2.3%, p [ 0.05), nor any difference in VC dysfunction when formally examined (4.9% vs 4.1%, p [ 0.05). Conclusions In image-positive, first time, adult PHPT cases, tPTx is as safe and effective as BNE, with both achieving excellent short-term results with minimal complications.
Introduction
& H. Ishii [email protected] 1
Department of ENT, Head & Neck Surgery, St George’s Hospital, Blackshaw Road, Tooting, London SW17 0QT, UK
2
Department of Endocrine Surgery, University Hospital Wales, Cardiff, UK
3
Department of Paediatric Surgery, Great Ormond Street Hospital, London, UK
4
Department of General Surgery, Aberdeen Royal Infirmary, Aberdeen, UK
The United Kingdom Registry of Endocrine and Thyroid Surgery (UKRETS) is a multi-centre, multi-disciplinary (General, Otolaryngology, Oral and Maxillofacial, Transplant and Vascular surgeons) database. It is the world’s largest endocrine surgery database and is maintained by the British Association of Endocrine and Thyroid Surgeons (BAETS) members. UKRETS has recognised potential deficiencies in care, including under-diagnosis and heterogeneous practise across the United Kingdom (UK). Therefore, the National Institute for Health and Care Excellence (NICE) have published guidelines on the management of primary hyperparathyroidism (PHPT) in the UK [1].
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World J Surg
Targeted parathyroidectomy (tPTx) in selected patients, with pre-operative localisation and intra-operative parathyroid hormone (ioPTH), have led to well-documented reductions in operating time and post-operative complications (especially hypocalcaemia) [2–5]. However, there is the potentia
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