Role of thymectomy in surgical treatment of renal hyperparathyroidism

IF 2.7 3区医学 Q1 SURGERY

American journal of surgery Pub Date : 2024-07-27 DOI:10.1016/j.amjsurg.2024.115864

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Abstract

Introduction

The role for routine thymectomy in patients with secondary or tertiary hyperparathyroidism (SHPT, THPT) is unclear. We aim to compare rates of recurrence and complications in patients who underwent subtotal parathyroidectomy with and without thymectomy.

Methods

Patients who underwent surgery for renal HPT at a tertiary endocrine surgery center between 2010 and 2022 were reviewed. Presence of parathyroid tissue in resected tissue was identified through pathology reports. A multivariate logistic regression was used to compare baseline characteristics, recurrence rates and complications between those who did and did not undergo thymectomy.

Results

Of 107 patients who underwent subtotal parathyroidectomy, 29 (27.1 %) underwent concomitant thymectomy. Recurrence occurred in 15 patients (14 %). Thymectomy did not affect recurrence (OR: 0.33, 95%CI: 0.06–1.28, p = 0.14), but was associated with permanent hypoparathyroidism (OR: 4.62, 95%CI: 1.67–13.18, p = 0.003). Fewer parathyroid specimens increased the odds of thymectomy (p = 0.04). Parathyroid glands were found in 6 thymectomy samples (20.7 %).

Conclusion

Thymectomy at the time of subtotal parathyroidectomy for renal HPT was not associated with disease recurrence, but increased likelihood of permanent hypoparathyroidism.

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胸腺切除术在肾性甲状旁腺功能亢进手术治疗中的作用

简介：常规胸腺切除术在继发性或三级甲状旁腺功能亢进症（SHPT、THPT）患者中的作用尚不明确。我们旨在比较接受甲状旁腺次全切除术和未接受胸腺切除术的患者的复发率和并发症发生率：方法：回顾 2010 年至 2022 年期间在一家三级内分泌外科中心接受肾性 HPT 手术的患者。通过病理报告确定切除组织中是否存在甲状旁腺组织。采用多变量逻辑回归比较了接受和未接受胸腺切除术的患者的基线特征、复发率和并发症：在接受甲状旁腺次全切除术的107名患者中，有29人（27.1%）同时接受了胸腺切除术。15名患者（14%）复发。胸腺切除术对复发没有影响（OR：0.33，95%CI：0.06-1.28，p = 0.14），但与永久性甲状旁腺功能减退有关（OR：4.62，95%CI：1.67-13.18，p = 0.003）。甲状旁腺标本较少会增加胸腺切除术的几率（p = 0.04）。6例胸腺切除术样本中发现了甲状旁腺（20.7%）：结论：在进行肾性HPT甲状旁腺次全切除术时进行胸腺切除与疾病复发无关，但会增加永久性甲状旁腺功能减退的可能性。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

American journal of surgery 医学-外科

CiteScore

5.00

自引率

6.70%

发文量

570

审稿时长

56 days

期刊介绍： The American Journal of Surgery® is a peer-reviewed journal designed for the general surgeon who performs abdominal, cancer, vascular, head and neck, breast, colorectal, and other forms of surgery. AJS is the official journal of 7 major surgical societies* and publishes their official papers as well as independently submitted clinical studies, editorials, reviews, brief reports, correspondence and book reviews.