A. Alhefdhi1, K. Cavanor1, D. Schneider1, R. Sippel1, H. Chen1 1University Of Wisconsin,Section Of Endocrine Surgery, Department Of Surgery,Madison, WI, USA
Introduction: With the development of intraoperative parathyroid hormone testing in the 1990s, the surgical approach to primary hyperparathyroidism (PHPT) progressively shifted from bilateral explorations to unilateral focused operations. However, focused explorations have been reported to be associated with a higher disease recurrence rate. We therefore examined the most recent trends in the operative approach for PHPT at a high volume institution.
Methods: A retrospective analysis of a prospectively collected database was performed on patients with PHPT who underwent parathyroidectomy at one institution between 2001 and 2013. Patients were divided into four quartiles based on time periods.
Results: 1741 patients underwent parathyroidectomy. In comparing the 4 time periods, the volume of patients increased from 106 in the early time period, 222 in the second period, 305 in the third period, and 1108 in the most recent period. There were no differences in demographics between the groups. However, the number of patients with mild PHPT increased from 7 (6.6%) in the early time period of 330 (29.8%) in the more recent period, respectively (p = 0.0001). Moreover, the number of patients who underwent bilateral neck exploration has gradually increased 22 (20.8%), 62 (27.9%), 90 (29.5%), and 394 (35.6%) respectively (p = 0.0053). Interestingly, this trend of more bilateral explorations has occurred in the midst of an unchanged percent of patients with a single adenoma as the etiology of the PHPT.
Conclusion: An increasing number of patients with mild PHPT are being referred for surgery. Bilateral exploration is increasingly utilized as primary treatment for the management of PHPT.