title: [Surgical treatment of recurrent parathyroid carcinoma with invasion of the upper aerodigestive tract].
abstract: OBJECTIVE
  To evaluate the factors contributed to the recurrence of parathyroid carcinoma with the invasion of the upper aerodigestive tract and the outcomes of reoperation.
  
  
  METHODS
  Six cases reviewed, in which the age ranged from 32 to 79 years old. The initial diagnoses and surgical procedures, the sites and surgical treatment of the recurrent disease, and the chemical markers, such as parathyroid hormone (PTH) and serum calcium, were retrospectively studied. The preoperative PTH levels ranged from 860 to 2830 ng/L. In 4 patients the recurrence diseases were founded in the tracheoesophageal groove, of them one with invasion of the larynx only and one with invasion of the larynx and pharynx in addition to the trachea and esophagus involvement. Selective neck dissection for level II, III, IV and VI was taken in all cases in addition to the removal of the local recurrent diseases. Recurrent laryngeal nerves were so badly embedded in tumor tissue that they were intentionally resected in 4 patients although they were functionally normal before operation. Prophylactic tracheostomy was carried out in 5 cases.
  
  
  RESULTS
  PTH level dropped more than 70% of that prior the operation at 10 min after the removal of the tumor-bearing tissues and to normal range within the first 2 hours postoperatively, and hypocalcemia disappeared in 2 days postoperatively. All cases experienced significant improvement in symptoms and signs in the first three days postoperatively. PTH and serum calcium levels were within normal range in 4 cases during the follow-up of 11 to 40 months, while hyperparathyroidism was encountered 8 and 11 months postoperatively in other 2 cases, respectively. Esophageal fistula, chylous fistula and dehiscence of sternotomy developed in 3 cases separately. Of 5 patients with tracheostomy, the tracheostomy tubes were removed two weeks in 4 cases and six weeks in the other one after operation.
  
  
  CONCLUSIONS
  Recurrent parathyroid carcinoma even with invasion of the upper aerodigestive tract still has promising surgical outcomes. Both the precise localization of the recurrent diseases and the intraoperative PTH assay are importance to the successful treatment of these diseases.
authors.affiliation: Department of Otorhinolaryngology Head and Neck Surgery, Beijing Shijitan Hospital, Beijing 100038, China. weibojun1015@sina.com
authors.forename: Bo-jun
authors.initials: BJ
authors.lastname: Wei
authors.forename: Hong
authors.initials: H
authors.lastname: Shen
authors.forename: Xiao-ping
authors.initials: XP
authors.lastname: Xing
authors.forename: Wei
authors.initials: W
authors.lastname: Ji
authors.forename: Liang
authors.initials: L
authors.lastname: Zhao
authors.forename: Jia
authors.initials: J
authors.lastname: Wang
authors.forename: Hong
authors.initials: H
authors.lastname: Xie
authors.forename: Xiao-hong
authors.initials: XH
authors.lastname: Zhou
authors.forename: Jin-shu
authors.initials: JS
authors.lastname: Yin
authors.forename: Tao
authors.initials: T
authors.lastname: Jiang
authors.forename: Hong
authors.initials: H
authors.lastname: Chang
authors.forename: Feng
authors.initials: F
authors.lastname: Shi
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D041981:Gastrointestinal Tract / Q000473:pathology; D006801:Humans; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000473:pathology; D010282:Parathyroid Neoplasms / Q000473:pathology* / Q000601:surgery*; D012086:Reoperation; D012137:Respiratory System / Q000473:pathology; D012189:Retrospective Studies