title: No need to abandon focused parathyroidectomy: a multicenter study of long-term outcome after surgery for primary hyperparathyroidism.
abstract: OBJECTIVE
  The aim of this study was to investigate long-term outcomes after focused parathyroidectomy (FPTX) and open 4-gland parathyroid exploration (OPTX) for primary hyperparathyroidism (pHPT).
  
  
  BACKGROUND
  Concerns about increased long-term recurrence rates after FPTX in conjunction with decreased operative times for OPTX have led some groups to abandon FPTX in favor of routine 4-gland exploration.
  
  
  METHODS
  This is a multicenter retrospective cohort study of patients undergoing parathyroidectomy for pHPT from 1990 to 2013. The patient cohort was divided into 2 groups, FPTX and OPTX, based on intention-to-treat analysis. The primary outcome measure was the persistence of pHPT. Secondary outcome measures were differences in the long-term recurrence rate of persisting pHPT and surgical complications.
  
  
  RESULTS
  A total of 4569 patients (3585 females) were included. The overall persistence and recurrence rates were 2.2% and 0.9%, respectively, after a median follow-up of 6.5 years. There were 2531 FPTX cases and 2038 OPTX cases. The initial persistence rate was higher for FPTX than for OPTX (2.7% vs 1.7%, P = 0.036); however, the long-term recurrence rate was not different (5-year 0.6% vs 0.4%, log-rank P = 0.08). Complications were more common in OPTX than in FPTX (7.6% vs 3.6%, P < 0.001).
  
  
  CONCLUSIONS
  FPTX was associated with fewer operative complications and an equivalent rate of long-term recurrence than with OPTX. Although initial persistence rates were higher after FPTX than after OPTX, most were readily resolved with subsequent early reoperation. FPTX should not be abandoned in patients with positive preoperative localization.
authors.affiliation: *University of Sydney Endocrine Surgical Unit, Sydney, New South Wales, Australia; and †Monash University Endocrine Surgery Unit, Melbourne, Victoria, Australia.
authors.forename: Olov
authors.initials: O
authors.lastname: Norlén
authors.forename: Kuan Chi
authors.initials: KC
authors.lastname: Wang
authors.forename: Yeng Kwang
authors.initials: YK
authors.lastname: Tay
authors.forename: William R
authors.initials: WR
authors.lastname: Johnson
authors.forename: Simon
authors.initials: S
authors.lastname: Grodski
authors.forename: Meei
authors.initials: M
authors.lastname: Yeung
authors.forename: Jonathan
authors.initials: J
authors.lastname: Serpell
authors.forename: Stan
authors.initials: S
authors.lastname: Sidhu
authors.forename: Mark
authors.initials: M
authors.lastname: Sywak
authors.forename: Leigh
authors.initials: L
authors.lastname: Delbridge
mesh_terms: D005260:Female; D006801:Humans; D049950:Hyperparathyroidism, Primary / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D061646:Operative Time; D016105:Parathyroidectomy / Q000009:adverse effects / Q000379:methods; D012008:Recurrence; D012086:Reoperation; D012189:Retrospective Studies; D016896:Treatment Outcome