Outcomes of Total Parathyroidectomy with Autotransplantation versus Subtotal Parathyroidectomy with Routine Addition of Thymectomy to both Groups: Single Center Experience of Secondary Hyperparathyroidism.
| Title: | Outcomes of Total Parathyroidectomy with Autotransplantation versus Subtotal Parathyroidectomy with Routine Addition of Thymectomy to both Groups: Single Center Experience of Secondary Hyperparathyroidism. |
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| Authors: | Sakman, Gürhan1, Parsak, Cem Kaan1 cparsak@yahoo.com, Balal, Mustafa2, Seydaoglu, Gülşah3, Eray, İsmail Cem1, Sarıtaş, Gökhan1, Demircan, Orhan4 |
| Source: | Balkan Medical Journal. Mar2014, p77-82. 6p. 1 Chart, 3 Graphs. |
| Subject Terms: | *PARATHYROID gland surgery, *THYMUS surgery, *ADRENALECTOMY, *AUTOGRAFTS, *CHI-squared test, *CHRONIC kidney failure, *COMPARATIVE studies, *FISHER exact test, *HYPERPARATHYROIDISM, *LONGITUDINAL method, *HEALTH outcome assessment, *STATISTICS, *T-test (Statistics), *U-statistics, *DATA analysis, *RANDOMIZED controlled trials, *TREATMENT effectiveness, *RETROSPECTIVE studies, *DATA analysis software |
| Abstract: | Background: Secondary hyperparathyroidism is a common acquired disorder seen in chronic renal failure. It may result in potentially serious complications including metabolic bone diseases, severe atherosclerosis and undesirable cardiovascular events. Parathyroidectomy is required in about 20% of patients after 3-10 years of dialysis and in up to 40% after 20 years. Aims: The aim of the current study was to evaluate the short-term and long-term outcomes of patients with secondary hyperparathyroidism who had undergone total parathyroidectomy with autotransplantation and thymectomy or subtotal parathyroidectomy with thymectomy by the same surgical team during the study period. Study Design: Retrospective comparative study. Methods: Clinical data of 50 patients who underwent parathyroid surgery for secondary hyperparathyroidism between 2003 and 2011 were reviewed retrospectively. Patients were divided into two subgroups of total parathyroidectomy with autotransplantation or subtotal parathyroidectorny. Thymectomy was routinely performed for both groups. Short term outcome parameters included intact parathyroid hormone, ionized calcium and alkaline phosphatase levels. Bone pain, bone fractures, persistent or recurrent disease were included in long term outcome parameters. Results: The mean duration of dialysis was eight years. The mean ionized calcium levels dropped significantly in the total parathyroidectomy with autotransplantation group (p=0.016). No serious postoperative complications were observed. Postoperative intravenous calcium supplementation was required in four patients in the total parathyroidectomy with autotransplantation group (total PTX+AT) and in three patients in the subtotal parathyroidectomy group (subtotal PTX). Postoperatively, all patients received oral calcium carbonate and calcitriol. The length of average hospital stay was 5 (3-10) days. Including nine patients who underwent successful renal transplantation pre-operative bone symptoms, hypercalcemia, hyperphosphatemia, and an increased alkaline phosphatase levels were improved or resolved in all patients. After a mean follow-up of 65 months, three patients (6%) had persistent and one (2%) had recurrent disease. Conclusion: Total parathroidectomy with autotransplantation is a beneficial and safe surgical procedure for patients on chronic dialysis with otherwise uncontrollable secondary hyperparathroidism and even in patients who have undergone renal transplantation after parathyroidectomy. Careful cervical exploration and routine thymectomy should be considered as a routine part of the surgical approach regardless of the preferred technique. [ABSTRACT FROM AUTHOR] |
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| Items | – Name: Title Label: Title Group: Ti Data: Outcomes of Total Parathyroidectomy with Autotransplantation versus Subtotal Parathyroidectomy with Routine Addition of Thymectomy to both Groups: Single Center Experience of Secondary Hyperparathyroidism. – Name: Author Label: Authors Group: Au Data: <searchLink fieldCode="AR" term="%22Sakman%2C+Gürhan%22">Sakman, Gürhan</searchLink><relatesTo>1</relatesTo><br /><searchLink fieldCode="AR" term="%22Parsak%2C+Cem+Kaan%22">Parsak, Cem Kaan</searchLink><relatesTo>1</relatesTo><i> cparsak@yahoo.com</i><br /><searchLink fieldCode="AR" term="%22Balal%2C+Mustafa%22">Balal, Mustafa</searchLink><relatesTo>2</relatesTo><br /><searchLink fieldCode="AR" term="%22Seydaoglu%2C+Gülşah%22">Seydaoglu, Gülşah</searchLink><relatesTo>3</relatesTo><br /><searchLink fieldCode="AR" term="%22Eray%2C+İsmail+Cem%22">Eray, İsmail Cem</searchLink><relatesTo>1</relatesTo><br /><searchLink fieldCode="AR" term="%22Sarıtaş%2C+Gökhan%22">Sarıtaş, Gökhan</searchLink><relatesTo>1</relatesTo><br /><searchLink fieldCode="AR" term="%22Demircan%2C+Orhan%22">Demircan, Orhan</searchLink><relatesTo>4</relatesTo> – Name: TitleSource Label: Source Group: Src Data: <searchLink fieldCode="JN" term="%22Balkan+Medical+Journal%22">Balkan Medical Journal</searchLink>. Mar2014, p77-82. 6p. 1 Chart, 3 Graphs. – Name: Subject Label: Subject Terms Group: Su Data: *<searchLink fieldCode="DE" term="%22PARATHYROID+gland+surgery%22">PARATHYROID gland surgery</searchLink><br />*<searchLink fieldCode="DE" term="%22THYMUS+surgery%22">THYMUS surgery</searchLink><br />*<searchLink fieldCode="DE" term="%22ADRENALECTOMY%22">ADRENALECTOMY</searchLink><br />*<searchLink fieldCode="DE" term="%22AUTOGRAFTS%22">AUTOGRAFTS</searchLink><br />*<searchLink fieldCode="DE" term="%22CHI-squared+test%22">CHI-squared test</searchLink><br />*<searchLink fieldCode="DE" term="%22CHRONIC+kidney+failure%22">CHRONIC kidney failure</searchLink><br />*<searchLink fieldCode="DE" term="%22COMPARATIVE+studies%22">COMPARATIVE studies</searchLink><br />*<searchLink fieldCode="DE" term="%22FISHER+exact+test%22">FISHER exact test</searchLink><br />*<searchLink fieldCode="DE" term="%22HYPERPARATHYROIDISM%22">HYPERPARATHYROIDISM</searchLink><br />*<searchLink fieldCode="DE" term="%22LONGITUDINAL+method%22">LONGITUDINAL method</searchLink><br />*<searchLink fieldCode="DE" term="%22HEALTH+outcome+assessment%22">HEALTH outcome assessment</searchLink><br />*<searchLink fieldCode="DE" term="%22STATISTICS%22">STATISTICS</searchLink><br />*<searchLink fieldCode="DE" term="%22T-test+%28Statistics%29%22">T-test (Statistics)</searchLink><br />*<searchLink fieldCode="DE" term="%22U-statistics%22">U-statistics</searchLink><br />*<searchLink fieldCode="DE" term="%22DATA+analysis%22">DATA analysis</searchLink><br />*<searchLink fieldCode="DE" term="%22RANDOMIZED+controlled+trials%22">RANDOMIZED controlled trials</searchLink><br />*<searchLink fieldCode="DE" term="%22TREATMENT+effectiveness%22">TREATMENT effectiveness</searchLink><br />*<searchLink fieldCode="DE" term="%22RETROSPECTIVE+studies%22">RETROSPECTIVE studies</searchLink><br />*<searchLink fieldCode="DE" term="%22DATA+analysis+software%22">DATA analysis software</searchLink> – Name: Abstract Label: Abstract Group: Ab Data: Background: Secondary hyperparathyroidism is a common acquired disorder seen in chronic renal failure. It may result in potentially serious complications including metabolic bone diseases, severe atherosclerosis and undesirable cardiovascular events. Parathyroidectomy is required in about 20% of patients after 3-10 years of dialysis and in up to 40% after 20 years. Aims: The aim of the current study was to evaluate the short-term and long-term outcomes of patients with secondary hyperparathyroidism who had undergone total parathyroidectomy with autotransplantation and thymectomy or subtotal parathyroidectomy with thymectomy by the same surgical team during the study period. Study Design: Retrospective comparative study. Methods: Clinical data of 50 patients who underwent parathyroid surgery for secondary hyperparathyroidism between 2003 and 2011 were reviewed retrospectively. Patients were divided into two subgroups of total parathyroidectomy with autotransplantation or subtotal parathyroidectorny. Thymectomy was routinely performed for both groups. Short term outcome parameters included intact parathyroid hormone, ionized calcium and alkaline phosphatase levels. Bone pain, bone fractures, persistent or recurrent disease were included in long term outcome parameters. Results: The mean duration of dialysis was eight years. The mean ionized calcium levels dropped significantly in the total parathyroidectomy with autotransplantation group (p=0.016). No serious postoperative complications were observed. Postoperative intravenous calcium supplementation was required in four patients in the total parathyroidectomy with autotransplantation group (total PTX+AT) and in three patients in the subtotal parathyroidectomy group (subtotal PTX). Postoperatively, all patients received oral calcium carbonate and calcitriol. The length of average hospital stay was 5 (3-10) days. Including nine patients who underwent successful renal transplantation pre-operative bone symptoms, hypercalcemia, hyperphosphatemia, and an increased alkaline phosphatase levels were improved or resolved in all patients. After a mean follow-up of 65 months, three patients (6%) had persistent and one (2%) had recurrent disease. Conclusion: Total parathroidectomy with autotransplantation is a beneficial and safe surgical procedure for patients on chronic dialysis with otherwise uncontrollable secondary hyperparathroidism and even in patients who have undergone renal transplantation after parathyroidectomy. Careful cervical exploration and routine thymectomy should be considered as a routine part of the surgical approach regardless of the preferred technique. [ABSTRACT FROM AUTHOR] – Name: AbstractSuppliedCopyright Label: Group: Ab Data: <i>Copyright of Balkan Medical Journal is the property of Galenos Yayinevi Tic. LTD. STI and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract.</i> (Copyright applies to all Abstracts.) |
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| RecordInfo | BibRecord: BibEntity: Identifiers: – Type: doi Value: 10.5152/balkanmedj.2014.9544 Languages: – Code: eng Text: English PhysicalDescription: Pagination: PageCount: 6 StartPage: 77 Subjects: – SubjectFull: PARATHYROID gland surgery Type: general – SubjectFull: THYMUS surgery Type: general – SubjectFull: ADRENALECTOMY Type: general – SubjectFull: AUTOGRAFTS Type: general – SubjectFull: CHI-squared test Type: general – SubjectFull: CHRONIC kidney failure Type: general – SubjectFull: COMPARATIVE studies Type: general – SubjectFull: FISHER exact test Type: general – SubjectFull: HYPERPARATHYROIDISM Type: general – SubjectFull: LONGITUDINAL method Type: general – SubjectFull: HEALTH outcome assessment Type: general – SubjectFull: STATISTICS Type: general – SubjectFull: T-test (Statistics) Type: general – SubjectFull: U-statistics Type: general – SubjectFull: DATA analysis Type: general – SubjectFull: RANDOMIZED controlled trials Type: general – SubjectFull: TREATMENT effectiveness Type: general – SubjectFull: RETROSPECTIVE studies Type: general – SubjectFull: DATA analysis software Type: general Titles: – TitleFull: Outcomes of Total Parathyroidectomy with Autotransplantation versus Subtotal Parathyroidectomy with Routine Addition of Thymectomy to both Groups: Single Center Experience of Secondary Hyperparathyroidism. Type: main BibRelationships: HasContributorRelationships: – PersonEntity: Name: NameFull: Sakman, Gürhan – PersonEntity: Name: NameFull: Parsak, Cem Kaan – PersonEntity: Name: NameFull: Balal, Mustafa – PersonEntity: Name: NameFull: Seydaoglu, Gülşah – PersonEntity: Name: NameFull: Eray, İsmail Cem – PersonEntity: Name: NameFull: Sarıtaş, Gökhan – PersonEntity: Name: NameFull: Demircan, Orhan IsPartOfRelationships: – BibEntity: Dates: – D: 01 M: 03 Text: Mar2014 Type: published Y: 2014 Identifiers: – Type: issn-print Value: 21463123 Titles: – TitleFull: Balkan Medical Journal Type: main |
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