Research output: Contribution to journal › Article › peer-review
Persistence of primary hyperparathyroidism: a single-center experience. / Бузанаков, Дмитрий Михайлович; Sleptsov, Ilya V.; Semenov, Arseny A.; Chernikov, Roman A.; Novokshonov, Konstantin Y.; Karelina, Yulia V.; Timofeeva, Natalya I.; Uspenskaya, Anna A.; Makarin, Viktor A.; Chinchuk, Igor K.; Fedorov, Elisey A.; Gorskaya, Natalya A.; Sablin, Ilya V.; Malugov, Yuriy N.; Alekseeva, Svetlana A.; Gerasimova, Ksenya A.; Pushkaruk, Alexander A.; Lyubimov, Mikhail V.; Rebrova, Dina V.; Shikhmagomedov, Shamil S.; Dzhumatov, Timur A.; Zolotoukho, Anna V.; Bubnov, Alexander N.
In: Langenbeck's Archives of Surgery, Vol. 407, No. 8, 12.2022, p. 3651-3659.Research output: Contribution to journal › Article › peer-review
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TY - JOUR
T1 - Persistence of primary hyperparathyroidism: a single-center experience
AU - Бузанаков, Дмитрий Михайлович
AU - Sleptsov, Ilya V.
AU - Semenov, Arseny A.
AU - Chernikov, Roman A.
AU - Novokshonov, Konstantin Y.
AU - Karelina, Yulia V.
AU - Timofeeva, Natalya I.
AU - Uspenskaya, Anna A.
AU - Makarin, Viktor A.
AU - Chinchuk, Igor K.
AU - Fedorov, Elisey A.
AU - Gorskaya, Natalya A.
AU - Sablin, Ilya V.
AU - Malugov, Yuriy N.
AU - Alekseeva, Svetlana A.
AU - Gerasimova, Ksenya A.
AU - Pushkaruk, Alexander A.
AU - Lyubimov, Mikhail V.
AU - Rebrova, Dina V.
AU - Shikhmagomedov, Shamil S.
AU - Dzhumatov, Timur A.
AU - Zolotoukho, Anna V.
AU - Bubnov, Alexander N.
PY - 2022/12
Y1 - 2022/12
N2 - Background: Parathyroidectomy is the only definitive treatment for primary hyperparathyroidism (PHPT). Precise localization of abnormal glands is a key to a successful surgery. Most patients are expected to be successfully treated with focused parathyroidectomy. However, this approach is associated with a risk of existing multiglandular disease which may lead to the postoperative persistence of PHPT. Methods: Eight hundred ten patients who underwent an initial surgery for PHPT at SPBU Hospital in 2017–2018 were included in the study. Preoperative imaging results were evaluated. Multivariate logistic regressions were calculated to estimate predictive values of preoperative data for the risk of postoperative persistence and risk of MGD. Results: Multiglandular disease was found to be a leading cause of persistent hyperparathyroidism. An anamnesis of thyroid surgery was found to be a significant risk factor for the persistence of hyperparathyroidism. The rate of persistence did not differ significantly between groups with bilateral neck exploration and focused parathyroidectomy. Age, sex, body mass index as well as negative results of preoperative US, MIBI, and 4D CT were not independently associated with a higher risk of MGD. All preoperative imaging modalities showed from low to moderate sensitivity for the detection of MGD. The frequency of cases of a missed second adenoma did not differ significantly between patients with concordant and discordant preoperative data. There were 7 cases with previously unsuspected second adenomas found solely due to bilateral neck exploration. Conclusions: None of the combination of preoperative visualization modalities was able to rule out the MGD and reliably identify patients for focused parathyroidectomy. Additional preoperative visualization failed to improve overall results. Bilateral neck exploration appeared to have a slight benefit for the patients with concordant preoperative imaging results.
AB - Background: Parathyroidectomy is the only definitive treatment for primary hyperparathyroidism (PHPT). Precise localization of abnormal glands is a key to a successful surgery. Most patients are expected to be successfully treated with focused parathyroidectomy. However, this approach is associated with a risk of existing multiglandular disease which may lead to the postoperative persistence of PHPT. Methods: Eight hundred ten patients who underwent an initial surgery for PHPT at SPBU Hospital in 2017–2018 were included in the study. Preoperative imaging results were evaluated. Multivariate logistic regressions were calculated to estimate predictive values of preoperative data for the risk of postoperative persistence and risk of MGD. Results: Multiglandular disease was found to be a leading cause of persistent hyperparathyroidism. An anamnesis of thyroid surgery was found to be a significant risk factor for the persistence of hyperparathyroidism. The rate of persistence did not differ significantly between groups with bilateral neck exploration and focused parathyroidectomy. Age, sex, body mass index as well as negative results of preoperative US, MIBI, and 4D CT were not independently associated with a higher risk of MGD. All preoperative imaging modalities showed from low to moderate sensitivity for the detection of MGD. The frequency of cases of a missed second adenoma did not differ significantly between patients with concordant and discordant preoperative data. There were 7 cases with previously unsuspected second adenomas found solely due to bilateral neck exploration. Conclusions: None of the combination of preoperative visualization modalities was able to rule out the MGD and reliably identify patients for focused parathyroidectomy. Additional preoperative visualization failed to improve overall results. Bilateral neck exploration appeared to have a slight benefit for the patients with concordant preoperative imaging results.
KW - Bilateral neck exploration
KW - Focused parathyroidectomy
KW - Multiglandular disease
KW - Preoperative imaging
KW - Primary hyperparathyroidism
UR - https://www.mendeley.com/catalogue/3ce6db8d-bdf9-3243-9590-86da4a447bea/
UR - http://www.scopus.com/inward/record.url?scp=85139991540&partnerID=8YFLogxK
U2 - 10.1007/s00423-022-02711-5
DO - 10.1007/s00423-022-02711-5
M3 - Article
VL - 407
SP - 3651
EP - 3659
JO - Langenbeck's Archives of Surgery
JF - Langenbeck's Archives of Surgery
SN - 1435-2443
IS - 8
ER -
ID: 99471452