title: Subtotal parathyroidectomy for secondary renal hyperparathyroidism: a 20-year surgical outcome study.
abstract: OBJECTIVE
  The aim of this study was to evaluate the outcomes of surgery for patients with secondary renal hyperparathyroidism (rHPT).
  
  
  METHODS
  This is a retrospective cohort study. Our institutional database was searched for eligible patients treated in 1995-2014. The inclusion criterion was initial parathyroidectomy for rHPT. Clinical and follow-up data were analyzed to estimate the cure rate (primary outcome), and morbidity (secondary outcome).
  
  
  RESULTS
  The study group comprised 297 patients (154 females, age 44.5 ± 13.7 years, follow-up 24.6 ± 10.5 months), including 268 (90.2 %) patients who had underwent subtotal parathyroidectomy, and 29 (9.8 %) who had had incomplete parathyroidectomy. Intraoperative iPTH assay was utilized in 207 (69.7 %) explorations. Persistent rHPT occurred in 12/268 (4.5 %) patients after subtotal parathyroidectomy and 5/29 (17.2 %) subjects after incomplete parathyroidectomy (p = 0.005). The patients operated on with intraoperative iPTH assay had a higher cure rate than non-monitored individuals, 201/207 (97.1 %) vs. 79/90 (87.8 %), respectively (p = 0.001). In-hospital mortality occurred in 1/297 (0.3 %) patient. The hungry bone syndrome occurred in 84/268 (31.3 %) patients after subtotal parathyroidectomy and 2/29 (6.9 %) subjects after incomplete parathyroidectomy (p = 0.006). Transient recurrent laryngeal nerve paresis occurred in 14/594 (2.4 %) and permanent in 5/594 (0.8 %) nerves at risk.
  
  
  CONCLUSIONS
  Subtotal parathyroidectomy is a safe and efficacious treatment for patients with rHPT. Utilization of intraoperative iPTH assay can guide surgical exploration and improve the cure rate.
authors.affiliation: Department of Endocrine Surgery, 3rd Chair of General Surgery, Jagiellonian University College of Medicine, 37 Prądnicka Street, 31-202, Krakow, Poland. okont@mp.pl.
authors.forename: Aleksander
authors.initials: A
authors.lastname: Konturek
authors.affiliation: Department of Endocrine Surgery, 3rd Chair of General Surgery, Jagiellonian University College of Medicine, 37 Prądnicka Street, 31-202, Krakow, Poland.
authors.forename: Marcin
authors.initials: M
authors.lastname: Barczyński
authors.affiliation: Department of Endocrine Surgery, 3rd Chair of General Surgery, Jagiellonian University College of Medicine, 37 Prądnicka Street, 31-202, Krakow, Poland.
authors.forename: Małgorzata
authors.initials: M
authors.lastname: Stopa
authors.affiliation: Department of Endocrine Surgery, 3rd Chair of General Surgery, Jagiellonian University College of Medicine, 37 Prądnicka Street, 31-202, Krakow, Poland.
authors.forename: Wojciech
authors.initials: W
authors.lastname: Nowak
mesh_terms: D000328:Adult; D015331:Cohort Studies; D005260:Female; D006801:Humans; D006962:Hyperparathyroidism, Secondary / Q000097:blood / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D016343:Monitoring, Intraoperative; D010281:Parathyroid Hormone / Q000097:blood; D016105:Parathyroidectomy; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D010281:Parathyroid Hormone
keywords: Intraoperative iPTH assay; Secondary renal hyperparathyroidism; Subtotal parathyroidectomy