Results of reoperation for hyperparathyroidism, with evaluation of preoperative localization studies.
During the past 3 years (June, 1974, to July, 1977), 51 patients underwent reoperation for persistent or recurrent hyperparathyroidism at the Mayo Clinica. The overall success rate for cervical reoperation was 72% and for mediastinal reoperation, was 64%. Arteriography alone provided accurate preoperative localization of missing parathyroid tumors in 11 of 17 patients at a cost per patient benefited of approximately $1,700. Selective thyroid venous sampling with parathormone assay alone correctly lateralized hyperfunctioning glands in only four of nine patients at a cost per patient benefited of approximately $1,900. When used in combination, these studies provided correct localization or lateralization of parathyroid tumors in five of seven patients at a cost per patient benefited of approximately $2,000. Three patients experienced significant neurological complications as a result of thyrocervical arteriography. There were no complications due to venous sampling. In patients who has undergone a less than thorough initial explorations due to venous sampling. In patients who had undergone a less than thorough initial exploration of the neck, the success rate for reoperation was not enhanced by obtaining preoperative tumor localization studies. However, in those patients who had had a thorough and systematic exploration of the neck at their first operations, the success rate for reoperation was almost doubled when preoperative arteriography or venous sampling (or both) was employed.
D000236:Adenoma / Q000175:diagnosis*; D000792:Angiography; D003362:Cost-Benefit Analysis; D005069:Evaluation Studies as Topic; D006801:Humans; D006961:Hyperparathyroidism / Q000209:etiology / Q000601:surgery*; D008479:Mediastinal Neoplasms / Q000175:diagnosis; D009333:Neck / Q000098:blood supply; D010280:Parathyroid Glands / Q000002:abnormalities / Q000098:blood supply; D010281:Parathyroid Hormone / Q000097:blood; D010282:Parathyroid Neoplasms / Q000175:diagnosis*; D011300:Preoperative Care; D012008:Recurrence; D013961:Thyroid Gland / Q000098:blood supply
D010281:Parathyroid Hormone