Focused, minimally invasive radio-guided parathyroidectomy: a feasible and safe option for elderly patients with primary hyperparathyroidism

• Published in: The Israel Medical Association journal 2003-05, Vol.5 (5), p.326-328
• Main Authors: Ben Haim, Menahem, Zwas, S T, Munz, Yaron, Rosin, Dan, Shabtai, Esther L, Kuriansky, Joseph, Olchovsky, David, Zmora, Oded, Scarlat, Alexander, Ayalon, Amram, Shabtai, Moshe
• Format: Article
• Language: English
• Subjects: Adenoma - complications; Adenoma - diagnostic imaging; Adenoma - surgery; Age Factors; Aged; Aged, 80 and over; Feasibility Studies; Female; Follow-Up Studies; Humans; Hyperparathyroidism - diagnostic imaging; Hyperparathyroidism - etiology; Hyperparathyroidism - surgery; Male; Minimally Invasive Surgical Procedures - adverse effects; Minimally Invasive Surgical Procedures - methods; Outcome Assessment (Health Care); Parathyroid Neoplasms - complications; Parathyroid Neoplasms - diagnostic imaging; Parathyroid Neoplasms - surgery; Parathyroidectomy - adverse effects; Parathyroidectomy - methods; Postoperative Complications; Surgery, Computer-Assisted - methods; Tomography, Emission-Computed, Single-Photon - adverse effects; Tomography, Emission-Computed, Single-Photon - methods
• ISSN: 1565-1088

Primary hyperparathyroidism in elderly patients is usually associated with additional co-morbidity that increases operative risk, and thus many geriatric patients are denied the benefit of surgery for a single parathyroid adenoma. To evaluate the safety and efficacy of accurate single photon emission computed tomography sestamibi scintigraphy, enabling precise localization of a single adenoma, in the geriatric population. Twenty-two patients aged 70 years and over with biochemically proven PHPT and with a single parathyroid adenoma identified by localization studies (sestamibi SPECT scan and ultrasonography) underwent 23 operations over 29 months (out of a total of 140 patients operated upon during the same period). Immediate preoperative sestamibi scintigraphy and marking of focal adenoma uptake followed by intraoperative hand-held gamma probe were used for the removal of the parathyroid adenoma by unilateral minimal access surgery. Associated major co-morbid conditions and pre- and postoperative calcium, phosphorus and parathormone levels were recorded. Indications for surgery were listed and operative and postoperative complications were noted. The patients were followed for a mean period of 17.7 months using the same parameters. The 22 patients with PHPT had a mean age of 76.3 +/- 5.9 years (range 70-88 years) and a female to male ratio of 13:9. Associated co-morbidity included ischemic heart disease (n = 15), hypertension (n = 22), non-insulin-dependent diabetes mellitus (n = 9), chronic obstructive pulmonary disease (n = 3), and previous neck surgery (n = 3). Mean preoperative serum calcium, phosphorous and PTH were 11.7 +/- 1.3 mg/dl, 2.5 +/- 0.5 mg/dl and 160.9 +/- 75.4 pg/ml respectively. In 20 of the 22 patients, surgery was successful in curing PHPT (91%). One patient had persistent hypercalcemia due to a missed adenoma, and repeat operation (by focused minimal accesss surgery) was successfully performed 2 weeks later. There were no complications and no morbidity postoperatively. Mean postoperative serum calcium, phosphorous and PTH were 9.6 +/- 1.2 mg/dl, 3.0 +/- 0.5 mg/dl and 35.2 +/- 24 pg/ml respectively. In all patients, serum calcium levels remained normal (9.7 +/- 1.3 mg/ml) after long-term follow-up (mean 17.7 +/- 9.6 months). Minimally invasive, radio-guided focused parathyroidectomy for a single adenoma is a safe and effective method to cure hyperparathyroidism in the elderly. Success of surgery is directly related to the surgeon's exp