Central Surgical Association| Volume 82, ISSUE 4, P466-473, October 1977

“Conservative” versus “liberal” approach to parathyroid neck exploration

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      Is the recent trend toward more radical parathyroid surgery justified? Surgical outcomes in three groups of 50 patients undergoing operation for primary hyperparathyroidism at the Mayo Clinic between January, 1974, and May, 1976, were compared. One group of patients was operated on by Surgeon A who used a “conservative” approach (removal of grossly enlarged glands only, with or without biopsy of one normal-sized gland). A second group was operated on by a Surgeon B, who used a more “liberal” approach (almost routine removal of at least two glands, removal of three and one-half glands when more than one gland was enlarged, and liberal use of biopsy identification). Symptomatic hypocalcemia requiring treatment occurred in 24% of patients after liberal neck exploration, as compared with 4% in the conservatively treated group. The liberal approach did not yield any higher cure rate. A third group of 50 patients was operated on by Surgeon B using the conservative approach. The incidence of postoperative hypocalcemia was reduced to 2%; one patient remained hypercalcemic. Symptomatic hypocalcemia, even if temporary, represents significant morbidity. A conservative approach to neck exploration in patients with primary hyperparathyroidism is recommended because it is associated with a very low incidence of temporary postoperative hypoparathyroidism (2 to 4%) and a high cure rate (99% in this series).
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        • Alveryd A.
        Parathyroid glands in thyroid surgery.
        Acta Chir Scand. 1968; 389 (Suppl): 1
        • Avioli L.V.
        The therapeutic approach to hypoparathyroidism.
        Am J Med. 1974; 57: 32
        • Black III, W.C.
        • Utley J.R.
        The differential diagnosis of parathyroid adenoma and chief cell hyperplasia.
        Am J Clin Pathol. 1968; 49: 761
        • Block M.A.
        • Frame B.
        • Jackson C.E.
        • et al.
        The extent of operation for primary hyperparathyroidism.
        Arch Surg. 1974; 109: 798
        • Bruining H.A.
        Surgical treatment of hyperparathyroidism: With an analysis of 267 cases.
        Royal Vangorcum, Publisher, Assen, The Netherlands1971
        • Clark O.H.
        • Way L.W.
        • Hunt T.K.
        Recurrent hyperparathyroidism.
        Ann Surg. 1976; 184: 391
        • Cope O.
        Hyperparathyroidism: Too little, too much surgery?.
        N Engl J Med. 1976; 295: 100
        • Cope O.
        • Keynes W.M.
        • Roth S.I.
        • et al.
        Primary chief-cell hyperplasia of the parathyroid glands: A new entity in the surgery of hyperparathyroidism.
        Ann Surg. 1958; 148: 375
        • Davies D.R.
        The surgery of primary hyperparathyroidism.
        Clin Endocrinol Metabol. 1974; 3: 253
        • Esselstyn Jr., C.B.
        • Levin H.S.
        • Eversman J.J.
        • et al.
        Reappraisal of parathyroid pathology in hyperparathyroidism.
        Surg Clin North Am. 1974; 54: 443
        • Gilmour J.R.
        The normal histology of the parathyroid glands.
        J Pathol Bacteriol. 1939; 48: 187
        • Gilmour J.R.
        • Martin W.J.
        The weight of the parathyroid glands.
        J Pathol Bacteriol. 1937; 44: 431
        • Goldman L.
        • Gordan G.S.
        • Roof B.S.
        The parathyroids: Progress, problems and practice.
        Curr Probl Surg. Aug. 1971; : 1
        • Haff R.C.
        • Armstrong R.G.
        Trends in the current management of primary hyperparathyroidism.
        Surgery. 1974; 75: 715
        • Haff R.C.
        • Ballinger W.F.
        Causes of recurrent hypercalcemia after parathyroidectomy for primary hyper-parathyroidism.
        Ann Surg. 1971; 173: 884
        • Hoehn J.G.
        • Beahrs O.H.
        • Woolner L.B.
        Unusual surgical lesions of the parathyroid gland.
        Am J Surg. 1969; 118: 770
        • Krementz E.T.
        • Yeager R.
        • Hawley W.
        • et al.
        The first 100 cases of parathyroid tumor from Charity Hospital of Louisiana.
        Ann Surg. 1971; 173: 872
        • Marsden P.
        • Day J.L.
        Hyperparathyroidism: the risk of recurrence.
        Clin Endocrinol. 1973; 2: 9
        • Muller H.
        True recurrence of hyperparathyroidism: Proposed criteria of recurrence.
        Br J Surg. 1975; 62: 556
        • Myers R.T.
        Followup study of surgically-treated primary hyperparathyroidism.
        Ann Surg. 1974; 179: 729
        • Palmer J.A.
        • Brown W.A.
        • Kerr W.H.
        • et al.
        The surgical aspects of hyperparathyroidism.
        Arch Surg. 1975; 110: 1004
        • Paloyan E.
        • Lawrence A.M.
        • Straus F.H.
        Grune & Stratton, Inc, New York1973
        • Paloyan E.
        • Lawrence A.M.
        • Straus F.H.
        Surgical treatment of hyperparathyroidism (letter to the editor).
        N Engl J Med. 1974; 291: 913
        • Romanus R.
        • Heimann P.
        • Nilsson O.
        • et al.
        Surgical treatment of hyperparathyroidism.
        Prog Surg. 1973; 12: 22
        • Roth S.I.
        Recent advances in parathyroid gland pathology.
        Am J Med. 1971; 50: 612
        • St. Goar W.T.
        • Roth S.I.
        Reply (letter to the editor).
        N Engl J Med. 1974; 291: 913
        • Satava Jr., R.M.
        • Beahrs O.H.
        • Scholz D.A.
        Success rate of cervical exploration for hyperparathyroidism.
        Arch Surg. 1975; 110: 625
        • Scholz D.A.
        • Purnell D.C.
        • Woolner L.B.
        • et al.
        Mediastinal hyperfunctioning parathyroid tumors: Review of 14 cases.
        Ann Surg. 1973; 178: 173
        • Wang C.-A.
        Surgery of the parathyroid glands.
        Adv Surg. 1971; 5: 109
        • Wang C.-A.
        The anatomic basis of parathyroid surgery.
        Ann Surg. 1976; 183: 271
        • Welsh D.A.
        Concerning the parathyroid glands: A critical, anatomical, and experimental study. II. Anatomy.
        J Anat Physiol. 1898; 32: 380
        • Werner S.
        • Hjern B.
        • Sjöberg H.E.
        Primary hyperparathyroidism: Analysis of findings in a series of 129 patients.
        Acta Chir Scand. 1974; 140: 618