Outcomes of Parathyroidectomy in Patients with Primary Hyperparathyroidism: A Systematic Review and Meta-analysis.
Parathyroidectomy is a definitive treatment for primary hyperparathyroidism. Patients contemplating this intervention will benefit from knowledge regarding the expected outcomes and potential risks of the currently available surgical options.



To appraise and summarize the available evidence regarding benefits and harms of minimally invasive parathyroidectomy (MIP) and bilateral neck exploration (BNE).



A comprehensive search of multiple databases (MEDLINE, EMBASE, and Scopus) from each database's inception to September 2014 was performed.



Eligible studies evaluated patients with primary hyperparathyroidism undergoing MIP or BNE.



Reviewers working independently and in duplicate extracted data and assessed the risk of bias.



We identified 82 observational studies and 6 randomized trials at moderate risk of bias. Most of them reported outcomes after MIP (n = 71). Using random-effects models to pool results across studies, the cure rate was 98 % (95 % CI 97-98 %, I (2) = 10 %) with BNE and 97 % (95 % CI 96-98 %, I (2) = 86 %) with MIP. Hypocalcemia occurred in 14 % (95 % CI 10-17 % I (2) = 93 %) of the BNE cases and in 2.3 % (95 % CI 1.6-3.1 %, I (2) = 87 %) with MIP (P < 0.001). There was a statistically significant lower risk of laryngeal nerve injury with MIP (0.3 %) than with BNE (0.9 %), but similar risk of infection (0.5 vs. 0.5 %) and mortality (0.1 vs. 0.5 %).



The available evidence, mostly observational, is at moderate risk of bias, and limited by indirect comparisons and inconsistency for some outcomes (cure rate, hypocalcemia).



MIP and BNE are both effective surgical techniques for the treatment of primary hyperparathyroidism. The safety profile of MIP appears superior to BNE (lower rate of hypocalcemia and recurrent laryngeal nerve injury).
Division of Endocrinology, Diabetes, Metabolism and Nutrition, Department of Internal Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA.|Knowledge and Evaluation Research Unit in Endocrinology, Mayo Clinic, Rochester, MN, USA.
Naykky M
NM
Singh Ospina
Knowledge and Evaluation Research Unit in Endocrinology, Mayo Clinic, Rochester, MN, USA.|Division of Endocrinology, Department of Internal Medicine, University Hospital "Dr. Jose E. Gonzalez", Monterrey, Mexico.
Rene
R
Rodriguez-Gutierrez
Division of Endocrinology, Diabetes, Metabolism and Nutrition, Department of Internal Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA.|Knowledge and Evaluation Research Unit in Endocrinology, Mayo Clinic, Rochester, MN, USA.
Spyridoula
S
Maraka
Division of Endocrinology, Diabetes, Metabolism and Nutrition, Department of Internal Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA.
Ana E
AE
Espinosa de Ycaza
Division of Endocrinology, Diabetes, Metabolism and Nutrition, Department of Internal Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA.
Sina
S
Jasim
Knowledge and Evaluation Research Unit in Endocrinology, Mayo Clinic, Rochester, MN, USA.|Department of Emergency Medicine, Mayo Clinic, Rochester, MN, USA.
Ana
A
Castaneda-Guarderas
Knowledge and Evaluation Research Unit in Endocrinology, Mayo Clinic, Rochester, MN, USA.|Mayo Graduate School, Mayo Clinic, Rochester, MN, USA.
Michael R
MR
Gionfriddo
Division of Pediatric Endocrinology, Mayo Clinic, Rochester, MN, USA.
Alaa
A
Al Nofal
Division of Endocrinology, Diabetes, Metabolism and Nutrition, Department of Internal Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA.|Knowledge and Evaluation Research Unit in Endocrinology, Mayo Clinic, Rochester, MN, USA.
Juan P
JP
Brito
Mayo Medical Library, Mayo Clinic, Rochester, MN, USA.
Patricia
P
Erwin
Division of Endocrine Surgery, Department of Surgery, Mayo Clinic, Rochester, MN, USA.
Melanie
M
Richards
Division of Endocrinology, Diabetes, Metabolism and Nutrition, Department of Internal Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA.
Robert
R
Wermers
Division of Endocrinology, Diabetes, Metabolism and Nutrition, Department of Internal Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA. montori.victor@mayo.edu.|Knowledge and Evaluation Research Unit in Endocrinology, Mayo Clinic, Rochester, MN, USA. montori.victor@mayo.edu.
Victor M
VM
Montori
D006801:Humans; D049950:Hyperparathyroidism, Primary / Q000601:surgery*; D006996:Hypocalcemia / Q000517:prevention & control; D019060:Minimally Invasive Surgical Procedures / Q000379:methods; D016105:Parathyroidectomy / Q000379:methods*; D061226:Recurrent Laryngeal Nerve Injuries / Q000517:prevention & control