title: Outcomes of Total Parathyroidectomy with Autotransplantation versus Subtotal Parathyroidectomy with Routine Addition of Thymectomy to both Groups: Single Center Experience of Secondary Hyperparathyroidism.
abstract: BACKGROUND
  Secondary hyperparathyroidism is a common acquired disorder seen in chronic renal failure. It may result in potentially serious complications including metabolic bone diseases, severe atherosclerosis and undesirable cardiovascular events. Parathyroidectomy is required in about 20% of patients after 3-10 years of dialysis and in up to 40% after 20 years.
  
  
  OBJECTIVE
  The aim of the current study was to evaluate the short-term and long-term outcomes of patients with secondary hyperparathyroidism who had undergone total parathyroidectomy with autotransplantation and thymectomy or subtotal parathyroidectomy with thymectomy by the same surgical team during the study period.
  
  
  METHODS
  Retrospective comparative study.
  
  
  METHODS
  Clinical data of 50 patients who underwent parathyroid surgery for secondary hyperparathyroidism between 2003 and 2011 were reviewed retrospectively. Patients were divided into two subgroups of total parathyroidectomy with autotransplantation or subtotal parathyroidectomy. Thymectomy was routinely performed for both groups. Short term outcome parameters included intact parathyroid hormone, ionized calcium and alkaline phosphatase levels. Bone pain, bone fractures, persistent or recurrent disease were included in long term outcome parameters.
  
  
  RESULTS
  The mean duration of dialysis was eight years. The mean ionized calcium levels dropped significantly in the total parathyroidectomy with autotransplantation group (p=0.016). No serious postoperative complications were observed. Postoperative intravenous calcium supplementation was required in four patients in the total parathyroidectomy with autotransplantation group (total PTX+AT) and in three patients in the subtotal parathyroidectomy group (subtotal PTX). Postoperatively, all patients received oral calcium carbonate and calcitriol. The length of average hospital stay was 5 (3-10) days. Including nine patients who underwent successful renal transplantation pre-operative bone symptoms, hypercalcemia, hyperphosphatemia, and an increased alkaline phosphatase levels were improved or resolved in all patients. After a mean follow-up of 65 months, three patients (6%) had persistent and one (2%) had recurrent disease.
  
  
  CONCLUSIONS
  Total parathroidectomy with autotransplantation is a beneficial and safe surgical procedure for patients on chronic dialysis with otherwise uncontrollable secondary hyperparathroidism and even in patients who have undergone renal transplantation after parathyroidectomy. Careful cervical exploration and routine thymectomy should be considered as a routine part of the surgical approach regardless of the preferred technique.
authors.affiliation: Department of General Surgery, Çukuruva University Faculty of Medicine, Adana, Turkey.
authors.forename: Gürhan
authors.initials: G
authors.lastname: Sakman
authors.affiliation: Department of General Surgery, Çukuruva University Faculty of Medicine, Adana, Turkey.
authors.forename: Cem Kaan
authors.initials: CK
authors.lastname: Parsak
authors.affiliation: Department of Nephrology, Çukuruva University Faculty of Medicine, Adana, Turkey.
authors.forename: Mustafa
authors.initials: M
authors.lastname: Balal
authors.affiliation: Department of Biostatistics, Çukuruva University Faculty of Medicine, Adana, Turkey.
authors.forename: Gülşah
authors.initials: G
authors.lastname: Seydaoglu
authors.affiliation: Department of General Surgery, Çukuruva University Faculty of Medicine, Adana, Turkey.
authors.forename: Ismail Cem
authors.initials: IC
authors.lastname: Eray
authors.affiliation: Department of General Surgery, Çukuruva University Faculty of Medicine, Adana, Turkey.
authors.forename: Gökhan
authors.initials: G
authors.lastname: Sarıtaş
authors.affiliation: Department of General Surgery, Acıbadem Hospital, Adana, Turkey.
authors.forename: Orhan
authors.initials: O
authors.lastname: Demircan
keywords: Autotransplantation; chronic renal failure; parathyroidectomy; secondary hyperparathyroidism; thymectomy