The results of surgery for mediastinal parathyroid tumors: a comparative study of 63 patients

• Published in: Langenbeck's archives of surgery 2010-09, Vol.395 (7), p.947-953
• Main Authors: Iacobone, Maurizio, Mondi, Isabella, Viel, Giovanni, Citton, Marilisa, Tropea, Saveria, Frego, Mauro, Favia, Gennaro
• Format: Article
• Language: English
• Subjects: Abdominal Surgery; Adult; Cardiac Surgery; Chi-Square Distribution; Choristoma - diagnosis; Choristoma - surgery; Cohort Studies; Endocrine Surgery; Female; Follow-Up Studies; General Surgery; Humans; Male; Mediastinal Diseases - diagnosis; Mediastinal Diseases - surgery; Mediastinoscopy - methods; Medicine; Medicine & Public Health; Middle Aged; Minimally Invasive Surgical Procedures - methods; Parathyroid Glands; Parathyroid Neoplasms - diagnosis; Parathyroid Neoplasms - surgery; Parathyroidectomy - methods; Retrospective Studies; Risk Assessment; Statistics, Nonparametric; Sternotomy - methods; Thoracic Surgery; Thoracic Surgery, Video-Assisted - methods; Traumatic Surgery; Treatment Outcome; Vascular Surgery
• ISSN: 1435-2443; 1435-2451
• DOI: 10.1007/s00423-010-0678-2

Purpose Parathyroidectomy for ectopic mediastinal hyperfunctioning glands could be performed by transcervical approach, sternotomy, thoracotomy, and recently by thoracoscopic and mediastinoscopic approaches. This study was aimed to analyze the results of traditional and video-assisted parathyroidectomy for mediastinal benign hyperfunctioning glands. Methods Fifty-one upper mediastinal exploration by a conventional cervicotomy, 12 by video-assisted approaches (two thoracoscopy and 10 transcervical mediastinoscopy) and six by sternotomy were performed in 63 patients with primary hyperparathyroidism. Results Video-assisted and sternotomic parathyroid explorations achieved biochemical cure in all cases; following conventional transcervical mediastinal exploration, a persistent hyperparathyroidism occurred in 11.8% of patients, who were subsequently cured by sternotomic approach. No complications occurred after video-assisted parathyroidectomy, while an overall morbidity rate of 50% and 10% was found after sternotomic and conventional cervicotomic approaches. Postoperative pain and hospital stay were significantly increased following sternotomy; patient's subjective cosmetic satisfaction was significantly higher after video-assisted and conventional cervicotomic approaches. Conclusions Conventional cervicotomic parathyroidectomy may achieve satisfactory results, especially for upper mediastinal glands. Sternotomic approaches are effective, but should be limited because of invasiveness and increased morbidity. In case of deep and lower hyperfunctioning mediastinal parathyroids, video-assisted approaches represent a less invasive, effective, and safe alternative and might be the technique of choice.