Localization and reoperation results for persistent and recurrent parathyroid carcinoma.
OBJECTIVE
Reoperation is safe and benefits patients with persistent and recurrent parathyroid carcinoma.


METHODS
Retrospective study. The mean follow-up time was 8.1 years (median, 7 years; range, 1-23 years).


METHODS
A university tertiary referral center.


METHODS
Eighteen patients treated for parathyroid carcinoma from 1966 to 1999.


RESULTS
The mean serum calcium level was 13.7 mg/dL (3.43 mmol/L), and the parathyroid hormone (PTH) level was 1.6 to 20 times the upper limit of normal. Fourteen of 18 patients had persistent or recurrent parathyroid carcinoma and underwent 54 reoperations (28 at our institution). Mean time to recurrence was 4.8 years (range, 1-20 years). Symptoms of hyperparathyroidism were relieved in 86% of patients who had reoperation (P<.05). Reoperation for parathyroid carcinoma (25 locoregional and 3 distant) significantly reduced and normalized the serum calcium and PTH levels in 75% and 62% of the cases, respectively (P<.001). The preoperative serum calcium level was a significant predictor of postreoperative normalization of the serum calcium level but not extent of initial resection, PTH level, time to recurrence, concordance of localization studies, or patient age and sex (P<.01). Surgical complications consisted of 5 unilateral and 1 bilateral permanent recurrent laryngeal nerve palsies (2 intentionally resected en bloc), 1 transient hypoparathyroidism, 1 wound seroma, and 1 tracheoesophageal fistula. The sensitivity rates of sestamibi scan (n = 14), magnetic resonance imaging (n = 15), computed tomographic scan (n = 6), ultrasound (n = 13), and selective venous catheterization with PTH measurement (n = 6) were 79%, 93%, 67%, 69%, and 83%, respectively.


CONCLUSIONS
Recurrence is common in patients with parathyroid carcinoma. Patients with this disease should have frequent, lifelong follow-up to ensure early detection of recurrence. Although reoperation for persistent or recurrent parathyroid carcinoma provides significant symptomatic relief and normalizes serum calcium and PTH levels in most patients, it is associated with some morbidity. Localizing studies of parathyroid carcinoma are helpful but do not detect all tumor foci.
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Department of Surgery, University of California, San Francisco, 513 Parnassus Ave, Room S343, San Francisco, CA 94134-0470, USA. tron@itsa.ucsf.edu
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D000328:Adult; D002118:Calcium / Q000097:blood; D002277:Carcinoma / Q000097:blood / Q000150:complications / Q000175:diagnosis / Q000556:secondary / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D006961:Hyperparathyroidism / Q000097:blood / Q000209:etiology; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000097:blood / Q000601:surgery*; D010281:Parathyroid Hormone / Q000097:blood; D010282:Parathyroid Neoplasms / Q000097:blood / Q000150:complications / Q000175:diagnosis / Q000601:surgery*; D016105:Parathyroidectomy / Q000009:adverse effects; D012086:Reoperation; D012189:Retrospective Studies; D017256:Technetium Tc 99m Sestamibi; D014055:Tomography, Emission-Computed / Q000379:methods; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome
D010281:Parathyroid Hormone; D017256:Technetium Tc 99m Sestamibi; D002118:Calcium