Long-term results of less than total parathyroidectomy for hyperparathyroidism in multiple endocrine neoplasia type 1.
BACKGROUND
Our aim was to assess long-term results after less than total parathyroidectomy for hyperparathyroidism in multiple endocrine neoplasia type 1.


METHODS
Of 1888 patients undergoing operation at our institution for primary hyperparathyroidism between 1972 and 2001, 83 (4.4%) had multiple endocrine neoplasia type 1. Outcome data were available for 79; 66 underwent subtotal parathyroidectomy, 55 (83%) of these with bilateral thymectomy. In 13 patients, only grossly enlarged glands were resected (mean 1.1 per patient) as the syndrome of multiple endocrine neoplasia type 1 was not yet evident or the initial exploration was performed elsewhere.


RESULTS
Follow-up has been 48 +/- 51 months (mean + SD). Intraoperative serum PTH assay decay in 20 patients was suggestive of cure in 18 patients, none of whom required reoperation. Nine patients (11%) required reoperation (3 required reoperation twice) after a mean interval of 77 +/- 53 months. Subtotal parathyroidectomy resulted in a lesser reoperation rate than resection of grossly enlarged glands (7% vs 30%, P =.02). At the time of review, 63 patients (80%) were normocalcemic, 10 (13%) hypocalcemic (2 after unsuccessful delayed autograft), and 7% hypercalcemic (none after reoperation). By Kaplan-Meier analysis, the rate of surgical cure (patients who are nonhypercalcemic) is 60% and 51% at 10 and 15 years, respectively.


CONCLUSIONS
Subtotal parathyroidectomy reduces the need for reoperation. Selective reoperation leads to long-lasting biochemic cure.
Arnalsteen
Laurent C
LC
Department of General and Endocrine Surgery, University Hospital of Lille, 1 rue Michel Polonovski, 59037 Lille Cedex, France.
Alesina
Piero F
PF
Quiereux
Jean Louis
JL
Farrel
Stephen G
SG
Patton
Francois N
FN
Carnaille
Bruno M
BM
Cardot-Bauters
Catherine M
CM
Wemeau
Jean Louis
JL
Proye
Charles A G
CA
D000293:Adolescent; D000328:Adult; D000368:Aged; D002118:Calcium / Q000097:blood; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D006934:Hypercalcemia / Q000209:etiology / Q000601:surgery; D006961:Hyperparathyroidism / Q000209:etiology* / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D018761:Multiple Endocrine Neoplasia Type 1 / Q000150:complications*; D016105:Parathyroidectomy / Q000379:methods*; D011183:Postoperative Complications; D012086:Reoperation; D016896:Treatment Outcome; D015043:Zollinger-Ellison Syndrome / Q000209:etiology / Q000601:surgery
D002118:Calcium