Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress 2023 EHA Congress 2023 ASCO Annual Meeting
Clinical Collections
Advances in Alzheimer’s

Keynote webinar | Spotlight on sleep in brain health

LIVE: Thursday 2nd May 2024, 18:00-19:30 (CEST)

Quality sleep is essential for health. But what happens to our brains when sleep patterns are disturbed? Join our experts to explore the interplay between sleep disruption and neurological diseases, and the questions that you need to be asking your patients to help you prevent the harmful effects of sleep deprivation.
ADVANCED SEARCH
Log in
Top
World Journal of Surgery
Published in: World Journal of Surgery 2/2012

01-02-2012

Initial Parathyroid Surgery in 606 Patients with Renal Hyperparathyroidism

Authors: Ralph Schneider, Emily P. Slater, Elias Karakas, Detlef K. Bartsch, Katja Schlosser

Published in: World Journal of Surgery | Issue 2/2012

Login to get access

Abstract

Background

The aim of the present study was to evaluate the outcome of different surgical procedures for patients on permanent dialysis who underwent initial parathyroidectomy for renal hyperparathyroidism (rHPT).

Methods

Out of a prospective database of patients who underwent parathyroid surgery for rHPT between 1976 and 2009, patients on permanent dialysis who underwent initial parathyroidectomy were further analyzed regarding perioperative biochemical changes and postoperative outcome.

Results

A total of 606 patients were analyzed. Total parathyroidectomy with autotransplantation (group A) was performed in 504 patients, total parathyroidectomy without autotransplantation in 32 (group B), subtotal parathyroidectomy in 21 (group C), and incomplete parathyroidectomy in 49 (group D).
After surgery, mean calcium levels dropped from 2.76 to 1.91 mmol/l in group A, from 2.67 to 2.11 mmol/l in group B, from 2.70 to 2.09 mmol/l in group C, and from 2.65 to 1.94 mmol/l in group D. The parathyroid hormone level dropped from 1,371.4 pg/ml to 28.8 pg/ml in group A, from 1,078.4 pg/ml to 27.0 pg/ml in group B, from 2,377.9 pg/ml to 61.4 pg/ml in group C, and from 1,010.2 pg/ml to 99.5 pg/ml in group D. Persistent rHPT occurred in 2/504 patients from group A (0.4%), 0/32 patients from group B (0%), 1/21 patients from group C (4.8%), and 2/49 patients from group D (4.1%). After a mean follow-up of 57.6 months, recurrent rHPT occurred in 27/504 patients from group A (5.4%), in 0/32 patients from group B (0%), in 2/21 patients from group C (9.5%), and in 3/49 patients from group D (6.1%).

Conclusions

Total parathyroidectomy with or without autotransplantation is a feasible and safe surgical procedure for patients on permanent dialysis with otherwise uncontrollable rHPT.
Literature
1.
Slatopolsky E (1998) The role of calcium, phosphorus and vitamin D metabolism in the development of secondary hyperparathyroidism. Nephrol Dial Transplant 13(Suppl 3):3–8PubMedCrossRef
2.
Llach F (1995) Secondary hyperparathyroidism in renal failure: the trade-off hypothesis revisited. Am J Kidney Dis 25:663–679PubMedCrossRef
3.
Triponez F, Clark OH, Vanrenthergem Y et al (2008) Surgical treatment of persistent hyperparathyroidism after renal transplantation. Ann Surg 248:18–30PubMedCrossRef
4.
Fukagawa M, Kazama JJ, Shigematsu T (2002) Management of patients with advanced secondary hyperparathyroidism: the Japanese approach. Nephrol Dial Transplant 17:1553–1557PubMedCrossRef
5.
Arnold A, Brown MF, Urena P et al (1995) Monoclonality of parathyroid tumors in chronic renal failure and in primary parathyroid hyperplasia. J Clin Invest 95:2047–2053PubMedCrossRef
6.
Felsenfeld AJ (1997) Considerations for the treatment of secondary hyperparathyroidism in renal failure. J Am Soc Nephrol 8:993–1004PubMed
7.
Tominaga Y, Matsuoka S, Uno N et al (2008) Parathyroidectomy for secondary hyperparathyroidism in the era of calcimimetics. Ther Apher Dial 12(Suppl 1):S21–S26PubMedCrossRef
8.
Tominaga Y, Tanaka Y, Sato K et al (1997) Histopathology, pathophysiology, and indications for surgical treatment of renal hyperparathyroidism. Semin Surg Oncol 13:78–86PubMedCrossRef
9.
10.
Fassbinder W, Brunner FP, Brynger H et al (1991) Combined report on regular dialysis and transplantation in Europe, XX, 1989. Nephrol Dial Transplant 6(Suppl 1):5–35
11.
Stanbury SW, Lumb GA, Nicholson WF (1960) Elective subtotal parathyroidectomy for renal hyperparathyroidism. Lancet 1(7128):793–799PubMedCrossRef
12.
Rothmund M, Wagner PK, Schark C (1991) Subtotal parathyroidectomy versus total parathyroidectomy and autotransplantation in secondary hyperparathyroidism: a randomized trial. World J Surg 15:745–750. doi:10.​1007/​BF01665309 PubMedCrossRef
13.
Neonakis E, Wheeler MH, Krishnan H et al (1995) Results of surgical treatment of renal hyperparathyroidism. Arch Surg 130:643–648PubMedCrossRef
14.
Henry JF, Denizot A, Audiffret J et al (1990) Results of reoperations for persistent or recurrent secondary hyperparathyroidism in hemodialysis patients. World J Surg 14:303–306. doi:10.​1007/​BF01658510 PubMedCrossRef
15.
Ogg CS (1967) Total parathyroidectomy in treatment of secondary (renal) hyperparathyroidism. Br Med J 4:331–334PubMedCrossRef
16.
Gasparri G, Camandona M, Abbona GC et al (2001) Secondary and tertiary hyperparathyroidism: causes of recurrent disease after 446 parathyroidectomies. Ann Surg 233:65–69PubMedCrossRef
17.
Kaye M, D’Amour P, Henderson J (1989) Elective total parathyroidectomy without autotransplant in end-stage renal disease. Kidney Int 35:1390–1399PubMedCrossRef
18.
Kaye M, Rosenthall L, Hill RO et al (1993) Long-term outcome following total parathyroidectomy in patients with end-stage renal disease. Clin Nephrol 39:192–197PubMed
19.
Stracke S, Jehle PM, Sturm D et al (1999) Clinical course after total parathyroidectomy without autotransplantation in patients with end-stage renal failure. Am J Kidney Dis 33:304–311PubMedCrossRef
20.
Ockert S, Willeke F, Richter A et al (2002) Total parathyroidectomy without autotransplantation as a standard procedure in the treatment of secondary hyperparathyroidism. Langenbecks Arch Surg 387:204–209PubMedCrossRef
21.
22.
Saunders RN, Karoo R, Metcalfe MS et al (2005) Four gland parathyroidectomy without reimplantation in patients with chronic renal failure. Postgrad Med J 81:255–258PubMedCrossRef
23.
Richards ML, Wormuth J, Bingener J et al (2006) Parathyroidectomy in secondary hyperparathyroidism: Is there an optimal operative management? Surgery 139:174–180PubMedCrossRef
24.
Nicholson ML, Veitch PS, Feehally J (1996) Parathyroidectomy in chronic renal failure: comparison of three operative strategies. J R Coll Surg Edinb 41:382–387PubMed
25.
Schlosser K, Zielke A, Rothmund M (2004) Medical and surgical treatment for secondary and tertiary hyperparathyroidism. Scand J Surg 93:288–297PubMed
26.
Schlosser K, Veit JA, Witte S et al (2007) Comparison of total parathyroidectomy without autotransplantation and without thymectomy versus total parathyroidectomy with autotransplantation and with thymectomy for secondary hyperparathyroidism: TOPAR PILOT-trial. Trials 8:22PubMedCrossRef
27.
28.
Tominaga Y, Matsuoka S, Sato T (2005) Surgical indications and procedures of parathyroidectomy in patients with chronic kidney disease. Ther Apher Dial 9:44–47PubMedCrossRef
29.
Dotzenrath C, Cupisti K, Goretzki E et al (2003) Operative treatment of renal autonomous hyperparathyroidism: cause of persistent or recurrent disease in 304 patients. Langenbecks Arch Surg 387:348–354PubMed
30.
Bro S, Olgaard K (1997) Effects of excess PTH on nonclassical target organs. Am J Kidney Dis 30:606–620PubMedCrossRef
31.
Ogata H, Koiwa F, Ito H et al (2006) Therapeutic strategies for secondary hyperparathyroidism in dialysis patients. Ther Apher Dial 10:355–363PubMedCrossRef
32.
Blacher J, Guerin AP, Pannier B et al (1999) Impact of aortic stiffness on survival in end-stage renal disease. Circulation 99:2434–2439PubMed
33.
Davies MR, Hruska KA (2001) Pathophysiological mechanisms of vascular calcification in end-stage renal disease. Kidney Int 60:472–479PubMedCrossRef
34.
Block GA, Hulbert-Shearon TE, Levin NW et al (1998) Association of serum phosphorus and calcium × phosphate product with mortality risk in chronic hemodialysis patients: a national study. Am J Kidney Dis 31:607–617PubMedCrossRef
35.
Rostand SG, Drueke TB (1999) Parathyroid hormone, vitamin D, and cardiovascular disease in chronic renal failure. Kidney Int 56:383–392PubMedCrossRef
36.
Block GA, Port FK (2000) Re-evaluation of risks associated with hyperphosphatemia and hyperparathyroidism in dialysis patients: recommendations for a change in management. Am J Kidney Dis 35:1226–1237PubMedCrossRef
37.
Ganesh SK, Stack AG, Levin NW et al (2001) Association of elevated serum PO(4), Ca × PO(4) product, and parathyroid hormone with cardiac mortality risk in chronic hemodialysis patients. J Am Soc Nephrol 12:2131–2138PubMed
38.
Foley RN, Parfrey PS (1998) Cardiovascular disease and mortality in ESRD. J Nephrol 11:239–245PubMed
39.
Coen G, Pierantozzi A, Spizzichino D et al (2010) Risk factors of one year increment of coronary calcifications and survival in hemodialysis patients. BMC Nephrol 11:10PubMedCrossRef
40.
Naves-Diaz M, Passlick-Deetjen J, Guinsburg A et al (2010) Calcium, phosphorus, PTH and death rates in a large sample of dialysis patients from Latin America. The CORES Study. Nephrol Dial Transplant 26:1938–1947PubMedCrossRef
41.
Pilz S, Tomaschitz A, Drechsler C et al (2010) Parathyroid hormone level is associated with mortality and cardiovascular events in patients undergoing coronary angiography. Eur Heart J 31:1591–1598PubMedCrossRef
42.
Pontoriero G, Cozzolino M, Locatelli F et al (2010) CKD patients: the dilemma of serum PTH levels. Nephron Clin Pract 116:c263–c268PubMedCrossRef
43.
Wada M, Nagano N, Nemeth EF (1999) The calcium receptor and calcimimetics. Curr Opin Nephrol Hypertens 8:429–433PubMedCrossRef
44.
Block GA, Martin KJ, de Francisco AL et al (2004) Cinacalcet for secondary hyperparathyroidism in patients receiving hemodialysis. N Engl J Med 350:1516–1525PubMedCrossRef
45.
Slatopolsky EA, Burke SK, Dillon MA, The RenaGel Study Group (1999) RenaGel, a nonabsorbed calcium- and aluminum-free phosphate binder, lowers serum phosphorus and parathyroid hormone. Kidney Int 55:299–307PubMedCrossRef
46.
Slatopolsky E, Dusso A, Brown A (1999) New analogs of vitamin D3. Kidney Int (Suppl) 73:S46–S51CrossRef
47.
Martin KJ, Gonzalez EA, Gellens ME et al (1998) Therapy of secondary hyperparathyroidism with 19-nor-1alpha, 25-dihydroxyvitamin D2. Am J Kidney Dis 32(2 Suppl 2):S61–S66PubMedCrossRef
48.
Martin KJ, Gonzalez EA, Gellens M et al (1998) 19-Nor-1-alpha-25-dihydroxyvitamin D2 (paricalcitol) safely and effectively reduces the levels of intact parathyroid hormone in patients on hemodialysis. J Am Soc Nephrol 9:1427–1432PubMed
49.
Hirata M, Katsumata K, Masaki T et al (1999) 22-Oxacalcitriol ameliorates high-turnover bone and marked osteitis fibrosa in rats with slowly progressive nephritis. Kidney Int 56:2040–2047PubMedCrossRef
50.
Wilson RE, Hampers CL, Bernstein DS et al (1971) Subtotal parathyroidectomy in chronic renal failure: a seven-year experience in a dialysis and transplant program. Ann Surg 174:640–654PubMedCrossRef
51.
Drueke TB, Zingraff J (1994) The dilemma of parathyroidectomy in chronic renal failure. Curr Opin Nephrol Hypertens 3:386–395PubMedCrossRef
52.
Kinnaert P, Salmon I, Decoster-Gervy C et al (2000) Long-term results of subcutaneous parathyroid grafts in uremic patients. Arch Surg 135:186–190PubMedCrossRef
53.
Patow CA, Norton JA, Brennan MF (1986) Vocal cord paralysis and reoperative parathyroidectomy. A prospective study. Ann Surg 203:282–285PubMedCrossRef
54.
55.
Hampl H, Steinmuller T, Frohling P et al (1999) Long-term results of total parathyroidectomy without autotransplantation in patients with and without renal failure. Miner Electrolyte Metab 25:161–170PubMedCrossRef
56.
Takagi H, Tominaga Y, Uchida K et al (1984) Subtotal versus total parathyroidectomy with forearm autograft for secondary hyperparathyroidism in chronic renal failure. Ann Surg 200:18–23PubMedCrossRef
57.
Tominaga Y, Uchida K, Haba T et al (2001) More than 1,000 cases of total parathyroidectomy with forearm autograft for renal hyperparathyroidism. Am J Kidney Dis 38(4 Suppl 1):S168–S171PubMedCrossRef
58.
Yu I, DeVita MV, Komisar A (1998) Long-term follow-up after subtotal parathyroidectomy in patients with renal failure. Laryngoscope 108:1824–1828PubMedCrossRef
59.
Hargrove GM, Pasieka JL, Hanley DA et al (1999) Short- and long-term outcome of total parathyroidectomy with immediate autografting versus subtotal parathyroidectomy in patients with end-stage renal disease. Am J Nephrol 19:559–564PubMedCrossRef
60.
Zaraca F, Mazzaferro S, Catarci M et al (1999) Prospective evaluation of total parathyroidectomy and autotransplantation for the treatment of secondary hyperparathyroidism. Arch Surg 134:68–72PubMedCrossRef
61.
Saliba W, El-Haddad B (2009) Secondary hyperparathyroidism: pathophysiology and treatment. J Am Board Fam Med 22:574–581PubMedCrossRef
62.
63.
64.
Borot S, Lapierre V, Carnaille B et al (2010) Results of cryopreserved parathyroid autografts: a retrospective multicenter study. Surgery 147:529–535PubMedCrossRef
65.
Caccitolo JA, Farley DR, van Heerden JA et al (1997) The current role of parathyroid cryopreservation and autotransplantation in parathyroid surgery: an institutional experience. Surgery 122:1062–1067PubMedCrossRef
66.
Eknoyan G, Levin NW (2003) K/DOQI clinical practice guidelines for bone metabolism and disease in chronic kidney disease. Am J Kidney Dis 42(4 Suppl 3):S1–S201CrossRef
67.
Society of Nephrology (2009) KDIGO clinical practice guideline for the diagnosis, evaluation, prevention, and treatment of chronic kidney disease-mineral and bone disorder (CKD-MBD). Kidney Int 76(Suppl 113):S1–S130
68.
Hampl H, Steinmuller T, Stabell U et al (1991) Recurrent hyperparathyroidism after total parathyroidectomy and autotransplantation in patients with long-term hemodialysis. Miner Electrolyte Metab 17:256–260PubMed
69.
Skinner KA, Zuckerbraun L (1996) Recurrent secondary hyperparathyroidism. An argument for total parathyroidectomy. Arch Surg 131:724–727PubMedCrossRef
70.
Tominaga Y, Numano M, Tanaka Y et al (1997) Surgical treatment of renal hyperparathyroidism. Semin Surg Oncol 13:87–96PubMedCrossRef
71.
72.
Neyer U, Hoerandner H, Haid A et al (2002) Total parathyroidectomy with autotransplantation in renal hyperparathyroidism: low recurrence after intra-operative tissue selection. Nephrol Dial Transplant 17:625–629PubMedCrossRef
73.
Akerstrom G, Malmaeus J, Bergstrom R (1984) Surgical anatomy of human parathyroid glands. Surgery 95:14–21PubMed
74.
75.
Nanka O, Sedy J, Vitkova I et al (2006) Surgical anatomy of parathyroid glands with emphasis on parathyroidectomy. Prague Med Rep 107:261–272PubMed
76.
Metadata
Title
Initial Parathyroid Surgery in 606 Patients with Renal Hyperparathyroidism
Authors
Ralph Schneider
Emily P. Slater
Elias Karakas
Detlef K. Bartsch
Katja Schlosser
Publication date
01-02-2012
Publisher
Springer-Verlag
Published in
World Journal of Surgery / Issue 2/2012
Print ISSN: 0364-2313
Electronic ISSN: 1432-2323
DOI
https://doi.org/10.1007/s00268-011-1392-0

Other articles of this Issue 2/2012

World Journal of Surgery 2/2012 Go to the issue

OriginalPaper

Renal Vein Lengthening Using Gonadal Vein Reduces Surgical Difficulty in Living-Donor Kidney Transplantation

OriginalPaper

Survival after Lung Metastasectomy in Colorectal Cancer Patients with Previously Resected Liver Metastases

Letter

Value of Diagnostic and Therapeutic Laparoscopy for Abdominal Stab Wounds

OriginalPaper

Is Pretreatment Endoscopic Biopsy a Good Predictor of Signet Ring Cell Histology in Gastric Carcinoma?

OriginalPaper

Value of the Metastatic Lymph Node Ratio for Predicting the Prognosis of Non-Small-Cell Lung Cancer Patients

OriginalPaper

Impact of Clinical and Pathohistological Characteristics on the Incidence of Recurrence and Survival in Elderly Patients with Gastric Cancer