Abstract
Background
Hyperparathyroidism is an almost universal feature of multiple endocrine neoplasia
type 1 syndrome. We present a systematic review and meta-analysis of the postoperative
outcomes of patients undergoing initial operative treatment of primary hyperparathyroidism
complicating multiple endocrine neoplasia 1.
Methods
A comprehensive literature search was performed with a priori defined exclusion criteria
for studies comparing total parathyroidectomy, subtotal parathyroidectomy, and less
than subtotal parathyroidectomy.
Results
Twenty-one studies incorporating 1,131 patients (272 undergoing total parathyroidectomy,
510 subtotal parathyroidectomy, and 349 less than subtotal parathyroidectomy) were
identified. Pooled results revealed increased risk for long-term hypoparathyroidism
in total parathyroidectomy patients (relative risk 1.61; 95% confidence interval,
1.12−2.31; P = .009) versus those undergoing subtotal parathyroidectomy. In the less than subtotal
parathyroidectomy or subtotal parathyroidectomy comparison group, a greater risk for
recurrence of hyperparathyroidism (relative risk 1.37; 95% confidence interval, 1.05−1.79;
P = .02), persistence of hyperparathyroidism (relative risk 2.26; 95% confidence interval,
1.49−3.41; P = .0001), and reoperation for hyperparathyroidism (relative risk 2.48; 95% confidence
interval, 1.65−3.73; P < .0001) was noted for less than subtotal parathyroidectomy patients, albeit with
lesser risk for long-term for hypoparathyroidism (relative risk 0.47; 95% confidence
interval, 0.29−0.75; P = .002).
Conclusion
Subtotal parathyroidectomy compares favorably to total parathyroidectomy, exhibiting
similar recurrence and persistence rates with a decreased propensity for long-term
postoperative hypoparathyroidism. The benefit of the decreased risk of hypoparathyroidism
in less than subtotal parathyroidectomy is negated by the increase in the risk for
recurrence, persistence, and reoperation. Future studies evaluating the performance
of less than subtotal parathyroidectomy in specific multiple endocrine neoplasia 1
phenotypes should be pursued in an effort to delineate a patient-tailored, operative
approach that optimizes long-term outcomes.
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Article info
Publication history
Published online: September 29, 2020
Accepted:
August 7,
2020
Identification
Copyright
© 2020 Elsevier Inc. All rights reserved.
