Parathyroid Surgery in the Elderly: Should Minimally Invasive Surgery Be Abandoned?

• Published in: Annals of surgical oncology 2014-04, Vol.21 (4), p.1369-1373
• Main Authors: Mekel, Michal, Gilshtein, Hayim, Chapchay, Katya, Bishara, Bishara, Krausz, Michael M., Freund, Herbert R., Kluger, Yoram, Eid, Ahmed, Mazeh, Haggi
• Format: Article
• Language: English
• Subjects: Adenoma - complications; Adenoma - pathology; Adenoma - surgery; Adolescent; Adult; Aged; Aged, 80 and over; Biomarkers, Tumor - blood; Endocrine Tumors; Female; Follow-Up Studies; Humans; Hyperparathyroidism, Primary - blood; Hyperparathyroidism, Primary - etiology; Hyperparathyroidism, Primary - pathology; Male; Medicine; Medicine & Public Health; Middle Aged; Minimally Invasive Surgical Procedures - adverse effects; Neoplasm Recurrence, Local - blood; Neoplasm Recurrence, Local - etiology; Neoplasm Recurrence, Local - pathology; Neoplasm Staging; Neoplasms, Multiple Primary - blood; Neoplasms, Multiple Primary - etiology; Neoplasms, Multiple Primary - pathology; Oncology; Parathyroid Hormone - blood; Parathyroid Neoplasms - complications; Parathyroid Neoplasms - pathology; Parathyroid Neoplasms - surgery; Parathyroidectomy - adverse effects; Postoperative Complications - blood; Postoperative Complications - etiology; Prognosis; Radiopharmaceuticals; Retrospective Studies; Surgery; Surgical Oncology; Technetium Tc 99m Sestamibi; Young Adult
• ISSN: 1068-9265; 1534-4681
• DOI: 10.1245/s10434-013-3402-y

Background Single adenoma is the cause of 80 % of primary hyperparathyroidism (PHPT) resulting in wide acceptance of minimally invasive parathyroidectomy (MIP). The incidence of PHPT increases with age. Little information is available regarding the prevalence of multiglandular disease (MGD) in older patients. Methods The records of 537 patients that underwent parathyroid surgery between January 2005 and October 2012 at two endocrine surgery referral centers were retrospectively reviewed. Comparison was performed between patients younger than 65 and older than 65 years of age. Clinical variables included preoperative laboratories and imaging, extent of neck exploration, number of glands excised, and intraoperative parathyroid hormone levels during surgery. Results There were 374 (70 %) patients in the younger age group (YG) and 163 (30 %) patients in the older age group (OG). The mean age was 50 ± 0.5 and 71 ± 0.4 years, respectively. There was no difference between the groups in terms of gender or laboratory results. MGD was significantly more common in the OG (24 % vs. 12 %; p  = 0.001) and similarly MIP was less commonly completed in the OG (49 % vs. 68 %; p