Reoperation for parathyroid adenoma: A contemporary experience

• Published in: Surgery 2009-12, Vol.146 (6), p.1144-1155
• Main Authors: Powell, Anathea C., MD, Alexander, H. Richard, MD, Chang, Richard, MD, Marx, Stephen J., MD, Skarulis, Monica, MD, Pingpank, James F., MD, Bartlett, David L., MD, Hughes, Marybeth, MD, Weinstein, Lee S., MD, Simonds, William F., MD, Collins, Michael F., MD, Shawker, Thomas, MD, Chen, Clara C., MD, Reynolds, James, MD, Cochran, Craig, RN, Steinberg, Seth M., PhD, Libutti, Steven K., MD
• Format: Article
• Language: English
• Subjects: Adenoma - complications; Adenoma - diagnosis; Adenoma - surgery; Adolescent; Adult; Aged; Female; Humans; Hypercapnia - etiology; Hypercapnia - surgery; Hyperparathyroidism - surgery; Male; Middle Aged; Neoplasm Recurrence, Local - complications; Neoplasm Recurrence, Local - diagnosis; Neoplasm Recurrence, Local - surgery; Parathyroid Hormone - blood; Parathyroid Neoplasms - complications; Parathyroid Neoplasms - diagnosis; Parathyroid Neoplasms - surgery; Postoperative Complications - etiology; Recurrent Laryngeal Nerve Injuries; Reoperation; Retrospective Studies; Surgery; Treatment Outcome; Young Adult
• ISSN: 0039-6060; 1532-7361
• DOI: 10.1016/j.surg.2009.09.015

Background We reviewed reoperations for persistent or recurrent sporadic parathyroid adenoma to evaluate and compare our current results and outcomes to our previous experience. Methods From 1996 to 2008, 237 patients with persistent or recurrent hyperparathyroidism after failed operation underwent reoperation. Patients were re-explored with the assistance of non-invasive and sometimes invasive imaging. Results A missed adenoma was suspected pre-operatively in 163 patients. Reoperation resulted in long-term resolution of hypercalcemia in 92%. Adenomas were in entopic locations in 32%; the most frequent ectopic location was the thymus (20%). Sestamibi scanning and ultrasonography were the most successful non-invasive imaging studies (96% positive predictive value (PPV) and 84% PPV respectively). Forty-four percent of patients had a reoperation based solely on non-invasive imaging. Of the invasive procedures performed, arteriography resulted in the best localization (92% PPV). Permanent recurrent laryngeal nerve injury occurred in 1.8%. Conclusion Compared to our prior experience (1982–1995), outcomes remained similar (92% resolution of hypercalcemia and 1.8% recurrent nerve injury currently versus 96% and 1.3% previously). Fewer patients received invasive studies for pre-operative localization (56% vs 73%, respectively). The decreased use of invasive imaging is due to technical improvements and greater confidence in the combination of ultrasonography and sestamibi scanning.