title: Long-term effectiveness of localization studies and intraoperative parathormone monitoring in patients undergoing reoperative parathyroidectomy for persistent or recurrent hyperparathyroidism.
abstract: BACKGROUND
  Reoperative parathyroidectomy (RPTX) for persistent or recurrent hyperparathyroidism is associated with a high rate of operative failure. The long-term effectiveness of RPTX using localization studies and intraoperative parathormone monitoring (IPM) was examined.
  
  
  METHODS
  Retrospective analysis of prospectively collected data from patients undergoing targeted RPTX with IPM for persistent or recurrent hyperparathyroidism was performed. Persistent hyperparathyroidism was defined as elevated calcium and parathormone (PTH) levels above normal range less than 6 months after parathyroidectomy. Recurrent hyperparathyroidism was defined as elevated calcium and PTH levels greater than 6 months after successful parathyroidectomy. Sensitivity and positive predictive value (PPV) for sestamibi, surgeon-performed ultrasound, intraoperative PTH dynamics, and surgical outcomes were evaluated.
  
  
  RESULTS
  Of the 1,064 patients, 69 patients underwent 72 RPTXs with localizing studies and IPM. Sestamibi (n = 69) had a sensitivity of 74% and a PPV of 83%, whereas surgeon-performed ultrasound (n = 38) had a sensitivity of 55% and a PPV of 76%. IPM had a sensitivity of 100% and a PPV of 98%. An intraoperative PTH drop greater than or equal to 50% was predictive of operative success (P < .01). Overall, operative success and recurrence were 94% and 1.4%, with a mean patient follow-up of 59 ± 12.8 months.
  
  
  CONCLUSIONS
  RPTX can be performed in a targeted approach using preoperative localization studies and IPM, leading to a low rate of complications and a high rate of long-term operative success.
authors.affiliation: The DeWitt Daughtry Family Department of Surgery, Division of Surgical Endocrinology, University of Miami Leonard M. Miller School of Medicine, 1120 NW 14th Street, 4th Floor, Clinical Research Building 410P, Miami, FL 33136, USA. Electronic address: pparikh@med.miami.edu.
authors.forename: Punam P
authors.initials: PP
authors.lastname: Parikh
authors.affiliation: The DeWitt Daughtry Family Department of Surgery, Division of Surgical Endocrinology, University of Miami Leonard M. Miller School of Medicine, 1120 NW 14th Street, 4th Floor, Clinical Research Building 410P, Miami, FL 33136, USA.
authors.forename: Josefina C
authors.initials: JC
authors.lastname: Farra
authors.affiliation: The DeWitt Daughtry Family Department of Surgery, Division of Surgical Endocrinology, University of Miami Leonard M. Miller School of Medicine, 1120 NW 14th Street, 4th Floor, Clinical Research Building 410P, Miami, FL 33136, USA.
authors.forename: Bassan J
authors.initials: BJ
authors.lastname: Allan
authors.affiliation: The DeWitt Daughtry Family Department of Surgery, Division of Surgical Endocrinology, University of Miami Leonard M. Miller School of Medicine, 1120 NW 14th Street, 4th Floor, Clinical Research Building 410P, Miami, FL 33136, USA.
authors.forename: John I
authors.initials: JI
authors.lastname: Lew
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D006961:Hyperparathyroidism / Q000473:pathology* / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D016343:Monitoring, Intraoperative; D016105:Parathyroidectomy; D012008:Recurrence; D012086:Reoperation; D012189:Retrospective Studies; D013997:Time Factors; D016896:Treatment Outcome; D055815:Young Adult
keywords: Intraoperative parathormone monitoring; Localization studies; Persistent hyperparathyroidism; Recurrent hyperparathyroidism; Reoperative parathyroidectomy