title: The results of surgery for mediastinal parathyroid tumors: a comparative study of 63 patients.
abstract: OBJECTIVE
  Parathyroidectomy for ectopic mediastinal hyperfunctioning glands could be performed by transcervical approach, sternotomy, thoracotomy, and recently by thoracoscopic and mediastinoscopic approaches. This study was aimed to analyze the results of traditional and video-assisted parathyroidectomy for mediastinal benign hyperfunctioning glands.
  
  
  METHODS
  Fifty-one upper mediastinal exploration by a conventional cervicotomy, 12 by video-assisted approaches (two thoracoscopy and 10 transcervical mediastinoscopy) and six by sternotomy were performed in 63 patients with primary hyperparathyroidism.
  
  
  RESULTS
  Video-assisted and sternotomic parathyroid explorations achieved biochemical cure in all cases; following conventional transcervical mediastinal exploration, a persistent hyperparathyroidism occurred in 11.8% of patients, who were subsequently cured by sternotomic approach. No complications occurred after video-assisted parathyroidectomy, while an overall morbidity rate of 50% and 10% was found after sternotomic and conventional cervicotomic approaches. Postoperative pain and hospital stay were significantly increased following sternotomy; patient's subjective cosmetic satisfaction was significantly higher after video-assisted and conventional cervicotomic approaches.
  
  
  CONCLUSIONS
  Conventional cervicotomic parathyroidectomy may achieve satisfactory results, especially for upper mediastinal glands. Sternotomic approaches are effective, but should be limited because of invasiveness and increased morbidity. In case of deep and lower hyperfunctioning mediastinal parathyroids, video-assisted approaches represent a less invasive, effective, and safe alternative and might be the technique of choice.
authors.affiliation: Endocrine Surgery Unit, Department of Surgical and Gastroenterological Sciences, University of Padua, Via Giustiniani, 2, 35128 Padua, Italy. maurizio.iacobone@unipd.it
authors.forename: Maurizio
authors.initials: M
authors.lastname: Iacobone
authors.forename: Isabella
authors.initials: I
authors.lastname: Mondi
authors.forename: Giovanni
authors.initials: G
authors.lastname: Viel
authors.forename: Marilisa
authors.initials: M
authors.lastname: Citton
authors.forename: Saveria
authors.initials: S
authors.lastname: Tropea
authors.forename: Mauro
authors.initials: M
authors.lastname: Frego
authors.forename: Gennaro
authors.initials: G
authors.lastname: Favia
mesh_terms: D000328:Adult; D016009:Chi-Square Distribution; D002828:Choristoma / Q000175:diagnosis / Q000601:surgery*; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008477:Mediastinal Diseases / Q000175:diagnosis / Q000601:surgery*; D008481:Mediastinoscopy / Q000379:methods*; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures / Q000379:methods; D010280:Parathyroid Glands; D010282:Parathyroid Neoplasms / Q000175:diagnosis / Q000601:surgery*; D016105:Parathyroidectomy / Q000379:methods; D012189:Retrospective Studies; D018570:Risk Assessment; D018709:Statistics, Nonparametric; D056346:Sternotomy / Q000379:methods; D020775:Thoracic Surgery, Video-Assisted / Q000379:methods*; D016896:Treatment Outcome