دورية أكاديمية
Multimodal Preoperative Localization Improves Outcomes in Reoperative Parathyroidectomy: A 25-Year Surgical Experience.
| العنوان: | Multimodal Preoperative Localization Improves Outcomes in Reoperative Parathyroidectomy: A 25-Year Surgical Experience. |
|---|---|
| المؤلفون: | Patel SG, Saunders ND, Jamshed S, Weber CJ, Sharma J |
| المصدر: | The American surgeon [Am Surg] 2019 Sep 01; Vol. 85 (9), pp. 939-943. |
| نوع المنشور: | Journal Article |
| اللغة: | English |
| بيانات الدورية: | Publisher: SAGE Publications in association with Southeastern Surgical Congress Country of Publication: United States NLM ID: 0370522 Publication Model: Print Cited Medium: Internet ISSN: 1555-9823 (Electronic) Linking ISSN: 00031348 NLM ISO Abbreviation: Am Surg Subsets: MEDLINE |
| أسماء مطبوعة: | Publication: 2020- : [Thousand Oaks, CA] : SAGE Publications in association with Southeastern Surgical Congress Original Publication: Atlanta Ga : Southeastern Surgical Congress |
| مواضيع طبية MeSH: | Reoperation*, Adenoma/*surgery , Hyperparathyroidism, Primary/*surgery , Parathyroid Neoplasms/*surgery , Parathyroidectomy/*methods, Adenoma/blood ; Adenoma/diagnostic imaging ; Adolescent ; Adult ; Aged ; Aged, 80 and over ; Calcium/blood ; Female ; Follow-Up Studies ; Humans ; Hyperparathyroidism, Primary/blood ; Hyperparathyroidism, Primary/diagnostic imaging ; Hypoparathyroidism ; Male ; Middle Aged ; Paralysis ; Parathyroid Hormone/blood ; Parathyroid Neoplasms/blood ; Parathyroid Neoplasms/diagnostic imaging ; Parathyroidectomy/adverse effects ; Postoperative Complications ; Single Photon Emission Computed Tomography Computed Tomography ; Technetium Tc 99m Sestamibi ; Young Adult |
| مستخلص: | Reoperative parathyroid surgery (REOPS) is often associated with lower cure rates and greater risk of nerve injury and hypoparathyroidism. The aim of this study was to evaluate cure rates, pathology, complications, and the efficacy of preoperative localization in patients requiring REOPS. Between 1992 and 2017, 2491 consecutive patients underwent parathyroidectomy for primary hyperparathyroidism. With Institutional Review Board approval, our prospectively collected parathyroidectomy outcomes database was queried for operative findings, outcomes, pathology, and localization methodology. Three hundred forty-six patients had REOPS (111 men/32% and 235 women/68%), with an overall cure rate of 91 per cent and a mean follow-up of 1.9 ± 0.7 years. The average preoperative serum calcium and parathyroid hormone were 11 ± 1 mg/dL and 373 ± 796 pg/mL, respectively. Normalization of intraoperative parathyroid hormone occurred in 248 patients and it was predictive of cure in 98.8 per cent of patients. A single adenoma was resected in 253 patients (75%), and the superior gland location was most common at 57 per cent. Ectopic glands were identified in only 33 patients. When preoperative imaging localized a lesion, a tumor was identified in that location in 75.4 per cent of sestamibi or SPECT/CT scans, 57.8 per cent of CT, 61.2 per cent of MRI, and 46.2 per cent of US. When at least two imaging modalities were concordant, sensitivity improved to 91.6 per cent ( P < 0.001). Complication rates of permanent hypoparathyroidism and recurrent nerve palsy occurred in 0.03 per cent of patients. REOP for recurrent or persistent primary hyperparathyroidism has a cure rate of 91 per cent. Most missed parathyroid tumors are in the neck, and multimodal imaging improves preoperative localization and success. |
| المشرفين على المادة: | 0 (Parathyroid Hormone) 971Z4W1S09 (Technetium Tc 99m Sestamibi) SY7Q814VUP (Calcium) |
| تواريخ الأحداث: | Date Created: 20191023 Date Completed: 20191030 Latest Revision: 20200108 |
| رمز التحديث: | 20231215 |
| PMID: | 31638503 |
| قاعدة البيانات: | MEDLINE |
Full Text Finder | تدمد: | 1555-9823 |
|---|