Surgical treatment of secondary hyperparathyroidism in elderly patients: an institutional experience.
BACKGROUND
Secondary hyperparathyroidism in elderly fragile patients presents clinical difficulties due to severity of symptoms and related comorbidity. The optimal surgical approach for this group of patients is still debated.


OBJECTIVE
The aim of the study was to define the optimal technique of parathyroidectomy in elderly patients with secondary hyperparathyroidism.


METHODS
Retrospective analysis in a series of 253 patients including 35 elderly individuals at a single institution was carried out. Postoperative parathyroid hormone decrease, surgical complications and symptoms control were analyzed for all patients in relation to the types of parathyroidectomy performed.


RESULTS
In elderly patients, total parathyroidectomy was the most used approach. Subtotal parathyroidectomy was mostly reserved for younger patients suitable for kidney transplantation. No elderly patients treated with total parathyroidectomy were autotransplanted. No significant difference in surgical complications was observed between younger and elderly patients and considering the different procedures. Adequate symptom control after surgery was achieved in almost 90% of patients. A limited rate of recurrence requiring repeat surgery was observed only after subtotal parathyroidectomy.


CONCLUSIONS
Considering the features of all types of parathyroidectomy, very low recurrence rate, contained postoperative hypocalcemia and limited complications following total parathyroidectomy, might represent specific advantages for elderly patients.


CONCLUSIONS
Total parathyroidectomy without parathyroid transplantation is safe for elderly patients with secondary hyperparathyroidism and a good alternative to the well-established total parathyroidectomy with autografting.
UOC Chirurgia Generale e Specialità Chirurgiche, Endocrine Surgery Unit, Medical School, S. Maria University Hospital, University of Perugia, via Tristano di Joannuccio 1, 05100, Terni, Italy. apolis74@yahoo.it.
Andrea
http://orcid.org/0000-0002-1319-1147
A
Polistena
UOC Chirurgia Generale e Specialità Chirurgiche, Endocrine Surgery Unit, Medical School, S. Maria University Hospital, University of Perugia, via Tristano di Joannuccio 1, 05100, Terni, Italy.
Alessandro
A
Sanguinetti
UOC Chirurgia Generale e Specialità Chirurgiche, Endocrine Surgery Unit, Medical School, S. Maria University Hospital, University of Perugia, via Tristano di Joannuccio 1, 05100, Terni, Italy.
Roberta
R
Lucchini
UOC Chirurgia Generale e Specialità Chirurgiche, Endocrine Surgery Unit, Medical School, S. Maria University Hospital, University of Perugia, via Tristano di Joannuccio 1, 05100, Terni, Italy.
Segio
S
Galasse
UOC Chirurgia Generale e Specialità Chirurgiche, Endocrine Surgery Unit, Medical School, S. Maria University Hospital, University of Perugia, via Tristano di Joannuccio 1, 05100, Terni, Italy.
Stefano
S
Avenia
UOC Chirurgia Generale e Specialità Chirurgiche, Endocrine Surgery Unit, Medical School, S. Maria University Hospital, University of Perugia, via Tristano di Joannuccio 1, 05100, Terni, Italy.
Massimo
M
Monacelli
Surgical Department, Skåne University Hospital, University of Lund, Malmö, Sweden.
Louis Banka
LB
Johnson
Surgical Department, Skåne University Hospital, University of Lund, Malmö, Sweden.
Bengt
B
Jeppsson
UOC Chirurgia Generale e Specialità Chirurgiche, Endocrine Surgery Unit, Medical School, S. Maria University Hospital, University of Perugia, via Tristano di Joannuccio 1, 05100, Terni, Italy.
Nicola
N
Avenia
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D016330:Frail Elderly; D006801:Humans; D006962:Hyperparathyroidism, Secondary / Q000209:etiology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D016105:Parathyroidectomy / Q000145:classification / Q000379:methods*; D011184:Postoperative Period; D012008:Recurrence; D051436:Renal Insufficiency, Chronic / Q000150:complications; D012086:Reoperation; D012189:Retrospective Studies; D014182:Transplantation, Autologous / Q000379:methods; D016896:Treatment Outcome
Elderly; Parathyroid autotransplantation; Secondary hyperparathyroidism; Subtotal parathyroidectomy; Total parathyroidectomy