Results of iterative surgery for persistent and recurrent parathyroid carcinoma.
OBJECTIVE
Parathyroid carcinoma (PC) is a rare cause of primary hyperparathyroidism. Surgery is the only effective treatment; re-operations are often required, because recurrences occur in most of the cases. The aim of this retrospective study was to analyse the rate of biochemical cure, clinical relief, sensitivity of localizing studies and morbidity after re-operations.


METHODS
From January 1980 to December 2000, 19 patients underwent surgery for PC. PC persisted or recurred in all cases. Fourteen re-operations were performed in six patients.


RESULTS
Twelve re-operations at loco-regional site and two pulmonary metastasectomies were performed. Iterative surgery achieved a symptomatic relief in 86% of cases and a transient biochemical remission only in one patient, but significantly reduced parathormone and calcemia. The sensitivity of scintigraphy, CT and ultrasonography was 86, 79 and 100%, respectively.


CONCLUSIONS
When recurrences occur, complete cure of PC is unlikely, despite re-operations. Iterative surgery is associated with some morbidity and never achieves a definitive cure, but provides significant clinical and biochemical palliation. Localizing studies are mandatory but do not detect all recurrences.
Iacobone
Maurizio
M
Endocrine Surgery Unit, Department of Surgical and Gastroenterological Sciences, University of Padua, Via Giustiniani, 2, 35128, Padua, Italy. maurizio.iacobone@unipd.it
Ruffolo
Cesare
C
Lumachi
Franco
F
Favia
Gennaro
G
D000328:Adult; D000368:Aged; D002277:Carcinoma / Q000175:diagnosis / Q000401:mortality / Q000556:secondary / Q000601:surgery*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000175:diagnosis / Q000601:surgery; D010282:Parathyroid Neoplasms / Q000175:diagnosis / Q000401:mortality / Q000601:surgery*; D011237:Predictive Value of Tests; D012086:Reoperation; D012680:Sensitivity and Specificity; D015996:Survival Rate