title: Parathyroid surgery in the elderly: should minimally invasive surgery be abandoned?
abstract: BACKGROUND
  Single adenoma is the cause of 80 % of primary hyperparathyroidism (PHPT) resulting in wide acceptance of minimally invasive parathyroidectomy (MIP). The incidence of PHPT increases with age. Little information is available regarding the prevalence of multiglandular disease (MGD) in older patients.
  
  
  METHODS
  The records of 537 patients that underwent parathyroid surgery between January 2005 and October 2012 at two endocrine surgery referral centers were retrospectively reviewed. Comparison was performed between patients younger than 65 and older than 65 years of age. Clinical variables included preoperative laboratories and imaging, extent of neck exploration, number of glands excised, and intraoperative parathyroid hormone levels during surgery.
  
  
  RESULTS
  There were 374 (70 %) patients in the younger age group (YG) and 163 (30 %) patients in the older age group (OG). The mean age was 50 ± 0.5 and 71 ± 0.4 years, respectively. There was no difference between the groups in terms of gender or laboratory results. MGD was significantly more common in the OG (24 % vs. 12 %; p = 0.001) and similarly MIP was less commonly completed in the OG (49 % vs. 68 %; p < 0.001). Cure rates were comparable between the OG and YG (93 % vs. 95 %; p = 0.27). In the OG, patients with MGD had significantly smaller glands as compared to patients with single adenomas in this group (331 ± 67 vs. 920 ± 97 mg; p = 0.006, respectively).
  
  
  CONCLUSIONS
  MGD in PHPT was found to be more prevalent in older patients. Planning a bilateral neck exploration should be considered in older patients, especially when a relatively small gland is suggested by imaging or encountered during surgery.
authors.affiliation: Department of General Surgery, Rambam-Health Care Campus, Haifa, Israel, m_mekel@rambam.health.gov.il.
authors.forename: Michal
authors.initials: M
authors.lastname: Mekel
authors.forename: Hayim
authors.initials: H
authors.lastname: Gilshtein
authors.forename: Katya
authors.initials: K
authors.lastname: Chapchay
authors.forename: Bishara
authors.initials: B
authors.lastname: Bishara
authors.forename: Michael M
authors.initials: MM
authors.lastname: Krausz
authors.forename: Herbert R
authors.initials: HR
authors.lastname: Freund
authors.forename: Yoram
authors.initials: Y
authors.lastname: Kluger
authors.forename: Ahmed
authors.initials: A
authors.lastname: Eid
authors.forename: Haggi
authors.initials: H
authors.lastname: Mazeh
mesh_terms: D000236:Adenoma / Q000150:complications / Q000473:pathology / Q000601:surgery*; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D014408:Biomarkers, Tumor / Q000097:blood; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D049950:Hyperparathyroidism, Primary / Q000097:blood / Q000209:etiology* / Q000473:pathology; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures / Q000009:adverse effects*; D009364:Neoplasm Recurrence, Local / Q000097:blood / Q000209:etiology* / Q000473:pathology; D009367:Neoplasm Staging; D009378:Neoplasms, Multiple Primary / Q000097:blood / Q000209:etiology* / Q000473:pathology; D010281:Parathyroid Hormone / Q000097:blood; D010282:Parathyroid Neoplasms / Q000150:complications / Q000473:pathology / Q000601:surgery*; D016105:Parathyroidectomy / Q000009:adverse effects*; D011183:Postoperative Complications / Q000097:blood / Q000209:etiology*; D011379:Prognosis; D019275:Radiopharmaceuticals; D012189:Retrospective Studies; D017256:Technetium Tc 99m Sestamibi; D055815:Young Adult
chemical_list: D014408:Biomarkers, Tumor; D010281:Parathyroid Hormone; D019275:Radiopharmaceuticals; D017256:Technetium Tc 99m Sestamibi