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World Journal of Surgery
Published in: World Journal of Surgery 10/2016

01-10-2016 | Original Scientific Report

Outcomes of Parathyroidectomy in Patients with Primary Hyperparathyroidism: A Systematic Review and Meta-analysis

Authors: Naykky M. Singh Ospina, Rene Rodriguez-Gutierrez, Spyridoula Maraka, Ana E. Espinosa de Ycaza, Sina Jasim, Ana Castaneda-Guarderas, Michael R. Gionfriddo, Alaa Al Nofal, Juan P. Brito, Patricia Erwin, Melanie Richards, Robert Wermers, Victor M. Montori

Published in: World Journal of Surgery | Issue 10/2016

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Abstract

Background

Parathyroidectomy is a definitive treatment for primary hyperparathyroidism. Patients contemplating this intervention will benefit from knowledge regarding the expected outcomes and potential risks of the currently available surgical options.

Purpose

To appraise and summarize the available evidence regarding benefits and harms of minimally invasive parathyroidectomy (MIP) and bilateral neck exploration (BNE).

Data sources

A comprehensive search of multiple databases (MEDLINE, EMBASE, and Scopus) from each database’s inception to September 2014 was performed.

Study selection

Eligible studies evaluated patients with primary hyperparathyroidism undergoing MIP or BNE.

Data extraction

Reviewers working independently and in duplicate extracted data and assessed the risk of bias.

Data synthesis

We identified 82 observational studies and 6 randomized trials at moderate risk of bias. Most of them reported outcomes after MIP (n = 71). Using random-effects models to pool results across studies, the cure rate was 98 % (95 % CI 97–98 %, I 2 = 10 %) with BNE and 97 % (95 % CI 96–98 %, I 2 = 86 %) with MIP. Hypocalcemia occurred in 14 % (95 % CI 10–17 % I 2 = 93 %) of the BNE cases and in 2.3 % (95 % CI 1.6–3.1 %, I 2 = 87 %) with MIP (P < 0.001). There was a statistically significant lower risk of laryngeal nerve injury with MIP (0.3 %) than with BNE (0.9 %), but similar risk of infection (0.5 vs. 0.5 %) and mortality (0.1 vs. 0.5 %).

Limitations

The available evidence, mostly observational, is at moderate risk of bias, and limited by indirect comparisons and inconsistency for some outcomes (cure rate, hypocalcemia).

Conclusion

MIP and BNE are both effective surgical techniques for the treatment of primary hyperparathyroidism. The safety profile of MIP appears superior to BNE (lower rate of hypocalcemia and recurrent laryngeal nerve injury).
Appendix
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Metadata
Title
Outcomes of Parathyroidectomy in Patients with Primary Hyperparathyroidism: A Systematic Review and Meta-analysis
Authors
Naykky M. Singh Ospina
Rene Rodriguez-Gutierrez
Spyridoula Maraka
Ana E. Espinosa de Ycaza
Sina Jasim
Ana Castaneda-Guarderas
Michael R. Gionfriddo
Alaa Al Nofal
Juan P. Brito
Patricia Erwin
Melanie Richards
Robert Wermers
Victor M. Montori
Publication date
01-10-2016
Publisher
Springer International Publishing
Published in
World Journal of Surgery / Issue 10/2016
Print ISSN: 0364-2313
Electronic ISSN: 1432-2323
DOI
https://doi.org/10.1007/s00268-016-3514-1

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