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Parathyroid Surgery in the Elderly: Should Minimally Invasive Surgery Be Abandoned?
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...
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| Published in: | Annals of surgical oncology 2014-04, Vol.21 (4), p.1369-1373 |
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| container_title | Annals of surgical oncology |
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| creator | Mekel, Michal Gilshtein, Hayim Chapchay, Katya Bishara, Bishara Krausz, Michael M. Freund, Herbert R. Kluger, Yoram Eid, Ahmed Mazeh, Haggi |
| description | 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
|
| doi_str_mv | 10.1245/s10434-013-3402-y |
| format | article |
| fullrecord | <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_miscellaneous_1504734882</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>1504734882</sourcerecordid><originalsourceid>FETCH-LOGICAL-c372t-679b26c6db0663ebba7a700d454a7f155d2b1d8415b7e58d18e8a038e846e0123</originalsourceid><addsrcrecordid>eNp1kE9LwzAYh4Mobk4_gBcJePFSzf90XmSOqYOJwvQc0iVzHV06k3bQb2-2ThHBSxKS5_29bx4AzjG6xoTxm4ARoyxBmCaUIZI0B6CLebxhIsWH8YxEmvSJ4B1wEsISISwp4segQxhFQgjaBdNX7XW1aHyZGzit_Yf1DcwdrBYWjgpjfdHcwumirAsDn3OXr3RRNHDsNjrkG_tTcW_hINPOlM6au1NwNNdFsGf7vQfeH0Zvw6dk8vI4Hg4myYxKUiVC9jMiZsJkcRZqs0xLLREyjDMt55hzQzJsUoZ5Ji1PDU5tqhGNKxMWYUJ74KrNXfvys7ahUqs8zGxRaGfLOijMEZOUpekWvfyDLsvauzjdjkJ9KnYUbqmZL0Pwdq7WPv7YNwojtTWuWuMqGldb46qJNRf75DpbWfNT8a04AqQFQnxy0dav1v-mfgHxZYpq</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>1504093682</pqid></control><display><type>article</type><title>Parathyroid Surgery in the Elderly: Should Minimally Invasive Surgery Be Abandoned?</title><source>Springer Nature</source><creator>Mekel, Michal ; Gilshtein, Hayim ; Chapchay, Katya ; Bishara, Bishara ; Krausz, Michael M. ; Freund, Herbert R. ; Kluger, Yoram ; Eid, Ahmed ; Mazeh, Haggi</creator><creatorcontrib>Mekel, Michal ; Gilshtein, Hayim ; Chapchay, Katya ; Bishara, Bishara ; Krausz, Michael M. ; Freund, Herbert R. ; Kluger, Yoram ; Eid, Ahmed ; Mazeh, Haggi</creatorcontrib><description>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
< 0.001). Cure rates were comparable between the OG and YG (93 % vs. 95 %;
p
= 0.27). In the OG, patients with MGD had significantly smaller glands as compared to patients with single adenomas in this group (331 ± 67 vs. 920 ± 97 mg;
p
= 0.006, respectively).
Conclusions
MGD in PHPT was found to be more prevalent in older patients. Planning a bilateral neck exploration should be considered in older patients, especially when a relatively small gland is suggested by imaging or encountered during surgery.</description><identifier>ISSN: 1068-9265</identifier><identifier>EISSN: 1534-4681</identifier><identifier>DOI: 10.1245/s10434-013-3402-y</identifier><identifier>PMID: 24306663</identifier><language>eng</language><publisher>Boston: Springer US</publisher><subject>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</subject><ispartof>Annals of surgical oncology, 2014-04, Vol.21 (4), p.1369-1373</ispartof><rights>Society of Surgical Oncology 2013</rights><rights>Society of Surgical Oncology 2014</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c372t-679b26c6db0663ebba7a700d454a7f155d2b1d8415b7e58d18e8a038e846e0123</citedby><cites>FETCH-LOGICAL-c372t-679b26c6db0663ebba7a700d454a7f155d2b1d8415b7e58d18e8a038e846e0123</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,780,784,27924,27925</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/24306663$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Mekel, Michal</creatorcontrib><creatorcontrib>Gilshtein, Hayim</creatorcontrib><creatorcontrib>Chapchay, Katya</creatorcontrib><creatorcontrib>Bishara, Bishara</creatorcontrib><creatorcontrib>Krausz, Michael M.</creatorcontrib><creatorcontrib>Freund, Herbert R.</creatorcontrib><creatorcontrib>Kluger, Yoram</creatorcontrib><creatorcontrib>Eid, Ahmed</creatorcontrib><creatorcontrib>Mazeh, Haggi</creatorcontrib><title>Parathyroid Surgery in the Elderly: Should Minimally Invasive Surgery Be Abandoned?</title><title>Annals of surgical oncology</title><addtitle>Ann Surg Oncol</addtitle><addtitle>Ann Surg Oncol</addtitle><description>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
< 0.001). Cure rates were comparable between the OG and YG (93 % vs. 95 %;
p
= 0.27). In the OG, patients with MGD had significantly smaller glands as compared to patients with single adenomas in this group (331 ± 67 vs. 920 ± 97 mg;
p
= 0.006, respectively).
Conclusions
MGD in PHPT was found to be more prevalent in older patients. Planning a bilateral neck exploration should be considered in older patients, especially when a relatively small gland is suggested by imaging or encountered during surgery.</description><subject>Adenoma - complications</subject><subject>Adenoma - pathology</subject><subject>Adenoma - surgery</subject><subject>Adolescent</subject><subject>Adult</subject><subject>Aged</subject><subject>Aged, 80 and over</subject><subject>Biomarkers, Tumor - blood</subject><subject>Endocrine Tumors</subject><subject>Female</subject><subject>Follow-Up Studies</subject><subject>Humans</subject><subject>Hyperparathyroidism, Primary - blood</subject><subject>Hyperparathyroidism, Primary - etiology</subject><subject>Hyperparathyroidism, Primary - pathology</subject><subject>Male</subject><subject>Medicine</subject><subject>Medicine & Public Health</subject><subject>Middle Aged</subject><subject>Minimally Invasive Surgical Procedures - adverse effects</subject><subject>Neoplasm Recurrence, Local - blood</subject><subject>Neoplasm Recurrence, Local - etiology</subject><subject>Neoplasm Recurrence, Local - pathology</subject><subject>Neoplasm Staging</subject><subject>Neoplasms, Multiple Primary - blood</subject><subject>Neoplasms, Multiple Primary - etiology</subject><subject>Neoplasms, Multiple Primary - pathology</subject><subject>Oncology</subject><subject>Parathyroid Hormone - blood</subject><subject>Parathyroid Neoplasms - complications</subject><subject>Parathyroid Neoplasms - pathology</subject><subject>Parathyroid Neoplasms - surgery</subject><subject>Parathyroidectomy - adverse effects</subject><subject>Postoperative Complications - blood</subject><subject>Postoperative Complications - etiology</subject><subject>Prognosis</subject><subject>Radiopharmaceuticals</subject><subject>Retrospective Studies</subject><subject>Surgery</subject><subject>Surgical Oncology</subject><subject>Technetium Tc 99m Sestamibi</subject><subject>Young Adult</subject><issn>1068-9265</issn><issn>1534-4681</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2014</creationdate><recordtype>article</recordtype><recordid>eNp1kE9LwzAYh4Mobk4_gBcJePFSzf90XmSOqYOJwvQc0iVzHV06k3bQb2-2ThHBSxKS5_29bx4AzjG6xoTxm4ARoyxBmCaUIZI0B6CLebxhIsWH8YxEmvSJ4B1wEsISISwp4segQxhFQgjaBdNX7XW1aHyZGzit_Yf1DcwdrBYWjgpjfdHcwumirAsDn3OXr3RRNHDsNjrkG_tTcW_hINPOlM6au1NwNNdFsGf7vQfeH0Zvw6dk8vI4Hg4myYxKUiVC9jMiZsJkcRZqs0xLLREyjDMt55hzQzJsUoZ5Ji1PDU5tqhGNKxMWYUJ74KrNXfvys7ahUqs8zGxRaGfLOijMEZOUpekWvfyDLsvauzjdjkJ9KnYUbqmZL0Pwdq7WPv7YNwojtTWuWuMqGldb46qJNRf75DpbWfNT8a04AqQFQnxy0dav1v-mfgHxZYpq</recordid><startdate>20140401</startdate><enddate>20140401</enddate><creator>Mekel, Michal</creator><creator>Gilshtein, Hayim</creator><creator>Chapchay, Katya</creator><creator>Bishara, Bishara</creator><creator>Krausz, Michael M.</creator><creator>Freund, Herbert R.</creator><creator>Kluger, Yoram</creator><creator>Eid, Ahmed</creator><creator>Mazeh, Haggi</creator><general>Springer US</general><general>Springer Nature B.V</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7TO</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>8AO</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>BENPR</scope><scope>CCPQU</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>H94</scope><scope>K9.</scope><scope>M0S</scope><scope>M1P</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><scope>7X8</scope></search><sort><creationdate>20140401</creationdate><title>Parathyroid Surgery in the Elderly: Should Minimally Invasive Surgery Be Abandoned?</title><author>Mekel, Michal ; Gilshtein, Hayim ; Chapchay, Katya ; Bishara, Bishara ; Krausz, Michael M. ; Freund, Herbert R. ; Kluger, Yoram ; Eid, Ahmed ; Mazeh, Haggi</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c372t-679b26c6db0663ebba7a700d454a7f155d2b1d8415b7e58d18e8a038e846e0123</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2014</creationdate><topic>Adenoma - complications</topic><topic>Adenoma - pathology</topic><topic>Adenoma - surgery</topic><topic>Adolescent</topic><topic>Adult</topic><topic>Aged</topic><topic>Aged, 80 and over</topic><topic>Biomarkers, Tumor - blood</topic><topic>Endocrine Tumors</topic><topic>Female</topic><topic>Follow-Up Studies</topic><topic>Humans</topic><topic>Hyperparathyroidism, Primary - blood</topic><topic>Hyperparathyroidism, Primary - etiology</topic><topic>Hyperparathyroidism, Primary - pathology</topic><topic>Male</topic><topic>Medicine</topic><topic>Medicine & Public Health</topic><topic>Middle Aged</topic><topic>Minimally Invasive Surgical Procedures - adverse effects</topic><topic>Neoplasm Recurrence, Local - blood</topic><topic>Neoplasm Recurrence, Local - etiology</topic><topic>Neoplasm Recurrence, Local - pathology</topic><topic>Neoplasm Staging</topic><topic>Neoplasms, Multiple Primary - blood</topic><topic>Neoplasms, Multiple Primary - etiology</topic><topic>Neoplasms, Multiple Primary - pathology</topic><topic>Oncology</topic><topic>Parathyroid Hormone - blood</topic><topic>Parathyroid Neoplasms - complications</topic><topic>Parathyroid Neoplasms - pathology</topic><topic>Parathyroid Neoplasms - surgery</topic><topic>Parathyroidectomy - adverse effects</topic><topic>Postoperative Complications - blood</topic><topic>Postoperative Complications - etiology</topic><topic>Prognosis</topic><topic>Radiopharmaceuticals</topic><topic>Retrospective Studies</topic><topic>Surgery</topic><topic>Surgical Oncology</topic><topic>Technetium Tc 99m Sestamibi</topic><topic>Young Adult</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Mekel, Michal</creatorcontrib><creatorcontrib>Gilshtein, Hayim</creatorcontrib><creatorcontrib>Chapchay, Katya</creatorcontrib><creatorcontrib>Bishara, Bishara</creatorcontrib><creatorcontrib>Krausz, Michael M.</creatorcontrib><creatorcontrib>Freund, Herbert R.</creatorcontrib><creatorcontrib>Kluger, Yoram</creatorcontrib><creatorcontrib>Eid, Ahmed</creatorcontrib><creatorcontrib>Mazeh, Haggi</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Oncogenes and Growth Factors Abstracts</collection><collection>Health & Medical Collection (Proquest)</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Medical Database (Alumni Edition)</collection><collection>ProQuest Pharma Collection</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>ProQuest Central (Alumni)</collection><collection>ProQuest Central</collection><collection>AUTh Library subscriptions: ProQuest Central</collection><collection>ProQuest One Community College</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>AIDS and Cancer Research Abstracts</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>PML(ProQuest Medical Library)</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest Central China</collection><collection>MEDLINE - Academic</collection><jtitle>Annals of surgical oncology</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Mekel, Michal</au><au>Gilshtein, Hayim</au><au>Chapchay, Katya</au><au>Bishara, Bishara</au><au>Krausz, Michael M.</au><au>Freund, Herbert R.</au><au>Kluger, Yoram</au><au>Eid, Ahmed</au><au>Mazeh, Haggi</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Parathyroid Surgery in the Elderly: Should Minimally Invasive Surgery Be Abandoned?</atitle><jtitle>Annals of surgical oncology</jtitle><stitle>Ann Surg Oncol</stitle><addtitle>Ann Surg Oncol</addtitle><date>2014-04-01</date><risdate>2014</risdate><volume>21</volume><issue>4</issue><spage>1369</spage><epage>1373</epage><pages>1369-1373</pages><issn>1068-9265</issn><eissn>1534-4681</eissn><abstract>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
< 0.001). Cure rates were comparable between the OG and YG (93 % vs. 95 %;
p
= 0.27). In the OG, patients with MGD had significantly smaller glands as compared to patients with single adenomas in this group (331 ± 67 vs. 920 ± 97 mg;
p
= 0.006, respectively).
Conclusions
MGD in PHPT was found to be more prevalent in older patients. Planning a bilateral neck exploration should be considered in older patients, especially when a relatively small gland is suggested by imaging or encountered during surgery.</abstract><cop>Boston</cop><pub>Springer US</pub><pmid>24306663</pmid><doi>10.1245/s10434-013-3402-y</doi><tpages>5</tpages></addata></record> |
| fulltext | fulltext |
| identifier | ISSN: 1068-9265 |
| ispartof | Annals of surgical oncology, 2014-04, Vol.21 (4), p.1369-1373 |
| issn | 1068-9265 1534-4681 |
| language | eng |
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| source | Springer Nature |
| 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 |
| title | Parathyroid Surgery in the Elderly: Should Minimally Invasive Surgery Be Abandoned? |
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