title: Total parathyroidectomy without autotransplantation in the surgical treatment of secondary hyperparathyroidism of chronic kidney disease.
abstract: BACKGROUND
  Subtotal parathyroidectomy (SP) and total parathyroidectomy (TP) with autotransplantation (TPai) are the most commonly adopted operations for the treatment of secondary hyperparathyroidism (2HPT). TP without autotransplantation had previously been confined to patients with advanced dialytic vintage, not eligible for kidney transplantation. Over the years, the procedure has gained more widespread use, but there is no precise knowledge on the immediate and long-term effects.
  
  
  METHODS
  The authors analyzed the immediate and long-term results of TP without autotransplantation, that is after the systematic removal of at least four glands in 20 patients operated for 2HPT, which were compared with results from TPai in an equal number of cases.
  
  
  RESULTS
  An improvement of the typical clinical symptoms was found in every patient undergoing surgery, and a significant reduction in intact PTH (iPTH) serum levels was achieved. Immediate normalization of iPTH level was observed in 11/20 TP cases, hypoparathyroidism in 4/20 and persistent HPT in 5/20 cases. One year of follow-up showed a slight increase in hypoparathyroidism, with 1/20 (5%) recurrence of the disease. One-year TPai results showed a similar percentage of euparathyroidism, as well as a higher longterm recurrence rate (4/20, 20%), although values do not reach statistical significance.
  
  
  CONCLUSIONS
  TP may still be considered the operation of choice in patients with aggressive forms of 2HPT or of advanced dialytic vintage, with no access to renal transplantation, because of its low recurrence rate (5%). Post-operative aparathyroidism is rare, while hypoparathyroidism and hypocalcemia can be well controled by medical treatment.
authors.affiliation: Department of Clinical and Experimental Internal Medicine F. Magrassi - A. Lanzara, IV Division of General Surgery and Endocrine Surgery, Second University of Naples, Italy. giovanni.conzo@unina2.it
authors.forename: G
authors.initials: G
authors.lastname: Conzo
authors.forename: A F
authors.initials: AF
authors.lastname: Perna
authors.forename: A A
authors.initials: AA
authors.lastname: Sinisi
authors.forename: A
authors.initials: A
authors.lastname: Palazzo
authors.forename: F
authors.initials: F
authors.lastname: Stanzione
authors.forename: C
authors.initials: C
authors.lastname: Della Pietra
authors.forename: A
authors.initials: A
authors.lastname: Livrea
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D006962:Hyperparathyroidism, Secondary / Q000209:etiology* / Q000601:surgery*; D007676:Kidney Failure, Chronic / Q000150:complications* / Q000601:surgery; D016030:Kidney Transplantation; D008297:Male; D008875:Middle Aged; D010280:Parathyroid Glands / Q000601:surgery / Q000637:transplantation*; D016105:Parathyroidectomy; D011183:Postoperative Complications; D011300:Preoperative Care; D014182:Transplantation, Autologous; D016896:Treatment Outcome