title: Long-term outcome in patients with primary hyperparathyroidism who underwent minimally invasive parathyroidectomy.
abstract: BACKGROUND
  Minimally invasive parathyroidectomy (MIP) has become a well-accepted treatment for selected patients with primary hyperparathyroidism (PHPT). However, few studies have evaluated long-term outcomes for this operative approach. We therefore chose to examine both the long-term symptom resolution and biochemical cure following MIP for PHPT.
  
  
  METHODS
  A total of 460 PHPT patients who underwent a MIP between 2004 and 2009 were successfully mailed a questionnaire that assessed preoperative and postoperative Parathyroidectomy Assessment of Symptoms (PAS) scores, most recent calcium and parathyroid hormone (PTH) levels, and information about any reoperation for PHPT. Long-term evaluation of symptomatic and biochemical cure was performed.
  
  
  RESULTS
  A total of 200 patients (43.5%) responded to our correspondence. The mean age of the patients was 58.7 ± 11.9 years, 74.5% were female, and 78.5% were Caucasian. The mean follow-up was 37 ± 19 months. The mean PAS scores fell by 117 ± 14 at long-term follow-up after MIP (P < 0.0001). All 13 symptoms comprising the PAS score diminished, of which ten did so significantly (P < 0.01). There was a significant drop in the mean serum calcium (preop. 11.1 mg/dl, postop. 9.6 mg/dl; P < 0.0001) and PTH (preop. 130.9 pg/ml, postop. 45.7 pg/ml; P < 0.0001) at long-term follow-up. Five patients (2.5%) developed recurrent disease (calcium > 10.5 mg/dl), and one (0.5%) underwent a reoperation for persistent disease and was subsequently cured.
  
  
  CONCLUSIONS
  This study demonstrates that MIP has long-term benefits in terms of excellent symptom resolution and a high biochemical cure rate (97%) in selected patients who have PHPT, preoperative localization with sestamibi scans, and assessment of intraoperative PTH level.
authors.affiliation: Endocrine Surgery Section, Department of Surgery, Johns Hopkins University School of Medicine, 600 North Wolfe Street, Blalock 606, Baltimore, MD 21287, USA.
authors.forename: Raghunandan
authors.initials: R
authors.lastname: Venkat
authors.forename: Guennadi
authors.initials: G
authors.lastname: Kouniavsky
authors.forename: Ralph P
authors.initials: RP
authors.lastname: Tufano
authors.forename: Eric B
authors.initials: EB
authors.lastname: Schneider
authors.forename: Alan P B
authors.initials: AP
authors.lastname: Dackiw
authors.forename: Martha A
authors.initials: MA
authors.lastname: Zeiger
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015415:Biomarkers / Q000097:blood; D002118:Calcium / Q000097:blood; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D049950:Hyperparathyroidism, Primary / Q000097:blood / Q000175:diagnosis / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures; D010281:Parathyroid Hormone / Q000097:blood; D016105:Parathyroidectomy / Q000379:methods*; D012086:Reoperation; D012189:Retrospective Studies; D011795:Surveys and Questionnaires; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D015415:Biomarkers; D010281:Parathyroid Hormone; D002118:Calcium
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