Top

Langenbeck's Archives of Surgery

Published in:

01-01-2013 | Original Article

Current trends in surgery for renal hyperparathyroidism (RHPT)—an international survey

Authors: Philipp Riss, Reza Asari, Christian Scheuba, Bruno Niederle

Published in: Langenbeck's Archives of Surgery | Issue 1/2013

Abstract

Purpose

The indications and results of preoperative localization, surgical strategy, indication for thymectomy, the application of intraoperative parathyroid hormone (PTH) monitoring, cryopreservation, and replantation of cryopreserved parathyroid tissue are not well documented in renal hyperparathyroidism (RHPT). The current trends in surgery for RHPT are to be evaluated in an international online survey.

Methods

Thirty-three questions regarding preoperative localization, surgical management of RHPT, intraoperative PTH monitoring, immediate/delayed autotransplantation (AT), and parathyroid cryopreservation were sent to members of various societies of endocrine surgeons.

Results

The data from 86 responses were analyzed, 61.6 % reported more than 50 parathyroid surgeries per year, and 62.7 % operated on less than 16 patients with RHPT per year. Subtotal or total parathyroidectomy (with/without AT) was the standard procedure in 98.8 % of the cases. Immediate AT was performed in 40.7 % (72.7 % in the forearm). In most patients, the onset of graft function was documented later than 1 week after AT. Cryopreservation was routinely performed in 27.4 %. In 10.7 %, replantation was performed in more than five patients (hypo- or aparathyroidism: n = 41; fresh graft failure: n = 13; reoperations: n = 9). Intraoperative PTH monitoring (in RHPT) was routinely used in 46.2 %. Its influence on surgical strategy was confirmed in 40 %.

Conclusions

The survey reflects the divergent strategies applied for AT, cryopreservation, and PTH monitoring in RHPT.

Available only for authorised users

Brancaccio D, Cozzolino M (2011) CKD-MBD: an endless story. J Nephrol 24(Suppl 18):S42–S48. doi:10.5301/JN.2011.8310 PubMedCrossRef

Group KDIGOKC-MW (2009) KDIGO clinical practice guideline for the diagnosis, evaluation, prevention, and treatment of Chronic Kidney Disease-Mineral and Bone Disorder (CKD-MBD). Kidney international. Supplement. doi:10.1038/ki.2009.188

National Kidney Foundation (2003) K/DOQI clinical practice guidelines for bone metabolism and disease in chronic kidney disease. Am J Kidney Dis 42 (4 (suppl 3)):S1-S203

Madorin C, Owen RP, Fraser WD, Pellitteri PK, Radbill B, Rinaldo A, Seethala RR, Shaha AR, Silver CE, Suh MY, Weinstein B, Ferlito A (2011) The surgical management of renal hyperparathyroidism. Eur Arch Otorhinolaryngol 269:1565–1576. doi:10.1007/s00405-011-1833-2

Moe SM, Chertow GM, Coburn JW, Quarles LD, Goodman WG, Block GA, Drueke TB, Cunningham J, Sherrard DJ, McCary LC, Olson KA, Turner SA, Martin KJ (2005) Achieving NKF-K/DOQI bone metabolism and disease treatment goals with cinacalcet HCl. Kidney Int 67(2):760–771. doi:10.1111/j.1523-1755.2005.67139.x PubMedCrossRef

Cunningham J, Danese M, Olson K, Klassen P, Chertow GM (2005) Effects of the calcimimetic cinacalcet HCl on cardiovascular disease, fracture, and health-related quality of life in secondary hyperparathyroidism. Kidney Int 68(4):1793–1800. doi:10.1111/j.1523-1755.2005.00596.x PubMedCrossRef

Kovacevic B, Ignjatovic M, Zivaljevic V, Cuk V, Scepanovic M, Petrovic Z, Paunovic I (2012) Parathyroidectomy for the attainment of NKF-K/DOQI™ and KDIGO recommended values for bone and mineral metabolism in dialysis patients with uncontrollable secondary hyperparathyroidism. Langenbecks Arch Surg/Deutsche Gesellschaft für Chirurgie 397(3):413–420. doi:10.1007/s00423-011-0901-9 CrossRef

Chowdhury MM, Dagash H, Pierro A (2007) A systematic review of the impact of volume of surgery and specialization on patient outcome. Br J Surg 94(2):145–161. doi:10.1002/bjs.5714 PubMedCrossRef

DGAV. http://www.dgav.de/savc/zertifizierungen/zertifizierungssystem-der-dgav/spezielle-anforderungen.html—c5889

10.

Stavrakis AI, Ituarte PH, Ko CY, Yeh MW (2007) Surgeon volume as a predictor of outcomes in inpatient and outpatient endocrine surgery. Surgery 142(6):887–899. doi:10.1016/j.surg.2007.09.003, discussion 887–899PubMedCrossRef

11.

Gasparri G, Camandona M, Bertoldo U, Sargiotto A, Papotti M, Raggio E, Nati L, Martino P, Felletti G, Mengozzi G (2009) The usefulness of preoperative dual-phase 99mTc MIBI-scintigraphy and IO-PTH assay in the treatment of secondary and tertiary hyperparathyroidism. Ann Surg 250(6):868–871. doi:10.1097/SLA.0b013e3181b0c7f4 PubMedCrossRef

12.

Vulpio C, Bossola M, De Gaetano A, Maresca G, Bruno I, Fadda G, Morassi F, Magalini SC, Giordano A, Castagneto M (2010) Usefulness of the combination of ultrasonography and 99mTc-sestamibi scintigraphy in the preoperative evaluation of uremic secondary hyperparathyroidism. Head and Neck 32(9):1226–1235. doi:10.1002/hed.21320 PubMedCrossRef

13.

Coulston JE, Egan R, Willis E, Morgan JD (2010) Total parathyroidectomy without autotransplantation for renal hyperparathyroidism. Br J Surg 97(11):1674–1679. doi:10.1002/bjs.7192 PubMedCrossRef

14.

Rayes N, Seehofer D, Schindler R, Reinke P, Kahl A, Ulrich F, Neuhaus P, Nussler NC (2008) Long-term results of subtotal vs total parathyroidectomy without autotransplantation in kidney transplant recipients. Arch Surg 143(8):756–761. doi:10.1001/archsurg.143.8.756, discussion 761PubMedCrossRef

15.

Sadideen HM, Taylor JD, Goldsmith DJ (2012) Total parathyroidectomy without autotransplantation after renal transplantation for tertiary hyperparathyroidism: long-term follow-up. Int Urol Nephrol 44(1):275–281. doi:10.1007/s11255-011-0069-9 PubMedCrossRef

16.

Schneider R, Slater EP, Karakas E, Bartsch DK, Schlosser K (2012) Initial parathyroid surgery in 606 patients with renal hyperparathyroidism. World J Surg 36(2):318–326. doi:10.1007/s00268-011-1392-0 PubMedCrossRef

17.

Sharma J, Raggi P, Kutner N, Bailey J, Zhang R, Huang Y, Herzog CA, Weber C (2012) Improved long-term survival of dialysis patients after near-total parathyroidectomy. J Am Coll Surg 214(4):400–407. doi:10.1016/j.jamcollsurg.2011.12.046 PubMedCrossRef

18.

Triponez F, Clark OH, Vanrenthergem Y, Evenepoel P (2008) Surgical treatment of persistent hyperparathyroidism after renal transplantation. Ann Surg 248(1):18–30. doi:10.1097/SLA.0b013e3181728a2d PubMedCrossRef

19.

Welch K, McHenry CR (2012) The role of transcervical thymectomy in patients with hyperparathyroidism. Am J Surg 203(3):292–295. doi:10.1016/j.amjsurg.2011.09.013, discussion 295–296PubMedCrossRef

20.

Schlosser K, Veit JA, Witte S, Fernández ED, Victor N, Knaebel H-P, Seiler CM, Rothmund M (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 8:22. doi:10.1186/1745-6215-8-22 PubMedCrossRef

21.

Lorenz K, Dralle H (2010) [Intraoperative parathyroid hormone determination for primary hyperparathyroidism]. Der Chirurg; Zeitschrift für alle Gebiete der operativen Medizen 81(7):636, 638–642. doi:10.1007/s00104-009-1885-7

22.

Riss P, Kaczirek K, Heinz G, Bieglmayer C, Niederle B (2007) A “defined baseline” in PTH monitoring increases surgical success in patients with multiple gland disease. Surgery 142(3):398–404. doi:10.1016/j.surg.2007.05.004 PubMedCrossRef

23.

Bieglmayer C, Kaczirek K, Prager G, Niederle B (2006) Parathyroid hormone monitoring during total parathyroidectomy for renal hyperparathyroidism: pilot study of the impact of renal function and assay specificity. Clin Chem 52(6):1112–1119. doi:10.1373/clinchem.2005.065490 PubMedCrossRef

24.

Kaczirek K, Prager G, Riss P, Wunderer G, Asari R, Scheuba C, Bieglmayer C, Niederle B (2006) Novel parathyroid hormone (1–84) assay as basis for parathyroid hormone monitoring in renal hyperparathyroidism. Arch Surg (Chicago, Ill: 1960) 141 (2):129–134; discussion 134. doi:10.1001/archsurg.141.2.129

25.

Kaczirek K, Riss P, Wunderer G, Prager G, Asari R, Scheuba C, Bieglmayer C, Niederle B (2005) Quick PTH assay cannot predict incomplete parathyroidectomy in patients with renal hyperparathyroidism. Surgery 137(4):431–435. doi:10.1016/j.surg.2004.12.017 PubMedCrossRef

26.

Müller-Stich BP, Brändle M, Binet I, Warschkow R, Lange J, Clerici T (2007) To autotransplant simultaneously or not—can intraoperative parathyroid hormone monitoring reliably predict early postoperative parathyroid hormone levels after total parathyroidectomy for hyperplasia? Surgery 142(1):47–56. doi:10.1016/j.surg.2007.02.003 PubMedCrossRef

27.

Ikeda Y, Kurihara H, Morita N, Miyabe R, Takami H (2007) The role of quick bio-intact PTH(1–84) assay during parathyroidectomy for secondary hyperparathyroidism. J Surg Res 141(2):306–310. doi:10.1016/j.jss.2006.11.025 PubMedCrossRef

28.

Wells SA, Gunnells JC, Shelburne JD, Schneider AB, Sherwood LM (1975) Transplantation of the parathyroid glands in man: clinical indications and results. Surgery 78(1):34–44PubMed

29.

Borot S, Lapierre V, Carnaille B, Goudet P, Penfornis A (2010) Results of cryopreserved parathyroid autografts: a retrospective multicenter study. Surgery 147(4):529–535. doi:10.1016/j.surg.2009.10.010 PubMedCrossRef

30.

Stotler BA, Reich-Slotky R, Schwartz J, Inabnet WB, Lee J, Wu F, Della-Latta P, Jhang JS (2011) Quality monitoring of microbial contamination of cryopreserved parathyroid tissue. Cell Tissue Bank 12(2):111–116. doi:10.1007/s10561-009-9169-5 PubMedCrossRef

31.

Echenique Elizondo M, Díaz-Aguirregoitia FJ, Amondarain JA, Vidaur F (2006) Parathyroid graft function after presternal subcutaneous autotransplantation for renal hyperparathyroidism. Arch Surg (Chicago, Ill: 1960) 141(1):33–38. doi:10.1001/archsurg.141.1.33

32.

Moffett JM, Suliburk J (2011) Parathyroid autotransplantation. Endocr Pract 17 Suppl 1:83–89. doi:10.4158/EP10377.RA

33.

Schneider R, Ramaswamy A, Slater EP, Bartsch DK, Schlosser K (2012) Cryopreservation of parathyroid tissue after parathyroid surgery for renal hyperparathyroidism: does it really make sense? World J Surg. doi:10.1007/s00268-012-1730-x

34.

Guerrero MA, Evans DB, Lee JE, Bao R, Bereket A, Gantela S, Griffin GD, Perrier ND (2008) Viability of cryopreserved parathyroid tissue: when is continued storage versus disposal indicated? World J Surg 32(5):836–839. doi:10.1007/s00268-007-9437-0 PubMedCrossRef

35.

Guerrero MA (2010) Cryopreservation of parathyroid glands. Int J Endocrinol 2010:829540. doi:10.1155/2010/829540

Title: Current trends in surgery for renal hyperparathyroidism (RHPT)—an international survey
Authors: Philipp Riss
Reza Asari
Christian Scheuba
Bruno Niederle
Publication date: 01-01-2013
Publisher: Springer-Verlag
Published in: Langenbeck's Archives of Surgery / Issue 1/2013
Print ISSN: 1435-2443
Electronic ISSN: 1435-2451
DOI: https://doi.org/10.1007/s00423-012-1025-6

At a glance: The STEP trials

Springer Medicine

Current trends in surgery for renal hyperparathyroidism (RHPT)—an international survey

Abstract

Purpose

Methods

Results

Conclusions

At a glance: The STEP trials

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusions

Please log in to get access to this content

Other articles of this Issue 1/2013

BMD improvements after operation for primary hyperparathyroidism

Cinacalcet effects on the perioperative course of patients with secondary hyperparathyroidism

Rubber transcystic drainage reduces the post-removal biliary complications in liver transplantation: a matched case–control study

Evaluation of sexual function in sexually active women 1 year after transvaginal NOTES: a prospective cohort study of 106 patients

Surgical management of Crohn’s disease

Feasibility of video-assisted bilateral neck exploration for patients with primary hyperparathyroidism and failed or discordant localization studies