title: Total parathyroidectomy with autotransplantation versus subtotal parathyroidectomy for renal hyperparathyroidism: A systematic review and meta-analysis.
abstract: OBJECTIVE
  Total parathyroidectomy with autotransplantation (TPTX + AT) and subtotal parathyroidectomy (SPTX) have been recommended to patients with renal hyperparathyroidism (RHPT).But which one is the best surgical method remains controversial. The aim of the present study was to compare the two surgical procedures with respect to long-term outcomes.
  
  
  METHODS
  A literature search was undertaken using Medline, EMBASE, CNKI and CBM from inception to May 2015. Study quality was assessed using the Newcastle-Ottawa Scale. Data were analyzed using Review Manager version 5.1.0.
  
  
  RESULTS
  A total of 13 studies comprising 1589 patients with renal failure were identified. There was no statistically significant difference in the rate of symptomatic improvement (OR 0.77; 95%CI 0.22 to 2.69; P = 0.68), radiological success (OR 0.17; 95%CI 0.02 to 1.56; P = 0.90), hyperparathyroidism recurrence or persistence (OR 1.31; 95%CI 0.65 to 2.65; P = 0.45) and reoperation (OR 1.55; 95%CI 0.62 to 3.86; P = 0.35) between TPTX + AT and SPTX. The effects on serum calcium and parathyroid hormone (PTH) were similar between two surgical protocols.
  
  
  CONCLUSIONS
  Both the TPTX + AT and SPTX were effective in treating RHPT and preventing recurrence. The difference between the two surgeries in recurrence or persistence and reoperation rate was insignificant. Further prospective, randomized controlled trials with high statistic power are necessary to comparative the two surgeries on the long term safety.
authors.affiliation: Department of Nephrology, Affiliated Qianfoshan Hospital of Shandong University, No. 16766 Jingshi Road, Jinan, 250014, China.
authors.forename: Juan
authors.initials: J
authors.lastname: Chen
authors.affiliation: Department of Nephrology, Affiliated Qianfoshan Hospital of Shandong University, No. 16766 Jingshi Road, Jinan, 250014, China.
authors.forename: Xiaoyan
authors.initials: X
authors.lastname: Jia
authors.affiliation: Department of Nephrology, Affiliated Qianfoshan Hospital of Shandong University, No. 16766 Jingshi Road, Jinan, 250014, China.
authors.forename: Xianglei
authors.initials: X
authors.lastname: Kong
authors.affiliation: Department of Nephrology, Affiliated Qianfoshan Hospital of Shandong University, No. 16766 Jingshi Road, Jinan, 250014, China.
authors.forename: Zunsong
authors.initials: Z
authors.lastname: Wang
authors.affiliation: Department of Nephrology, Affiliated Qianfoshan Hospital of Shandong University, No. 16766 Jingshi Road, Jinan, 250014, China.
authors.forename: Meiyu
authors.initials: M
authors.lastname: Cui
authors.affiliation: Department of Nephrology, Affiliated Qianfoshan Hospital of Shandong University, No. 16766 Jingshi Road, Jinan, 250014, China.
authors.forename: Dongmei
authors.initials: D
authors.lastname: Xu
mesh_terms: D000328:Adult; D015415:Biomarkers / Q000097:blood; D002118:Calcium / Q000097:blood; D016009:Chi-Square Distribution; D005260:Female; D006801:Humans; D006962:Hyperparathyroidism, Secondary / Q000097:blood / Q000175:diagnosis / Q000209:etiology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D010281:Parathyroid Hormone / Q000097:blood; D016105:Parathyroidectomy / Q000009:adverse effects / Q000379:methods*; D011183:Postoperative Complications / Q000209:etiology; D012008:Recurrence; D051437:Renal Insufficiency / Q000150:complications* / Q000175:diagnosis; D012307:Risk Factors; D013997:Time Factors; D014182:Transplantation, Autologous; D016896:Treatment Outcome
chemical_list: D015415:Biomarkers; C470125:PTH protein, human; D010281:Parathyroid Hormone; D002118:Calcium
keywords: Chronic kidney disease; Hyperparathyroidism; Meta-analysis; Parathyroidectomy