Subtotal Versus Total Parathyroidectomy for the Management of Tertiary Hyperparathyroidism: A Systematic Literature Review and Meta-Analysis of Optimal Surgical Modality.

IF 1 4区医学 Q3 SURGERY

American Surgeon Pub Date : 2025-02-01 Epub Date: 2024-10-11 DOI:10.1177/00031348241290615

Aaron L Albuck, Madeleine B Landau, Alexandra C LaForteza, Mohammad Hussein, Peter P Issa, Christina McCarthy, Mohamed Shama, Eman Toraih, Emad Kandil

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引用次数: 0

Abstract

Background: Surgery is the definitive treatment option for tertiary hyperparathyroidism (THPT), however, the optimal surgical approach remains unclear. We aimed to compare total parathyroidectomy (PTX) with auto-transplantation vs subtotal PTX for THPT through a systematic review and meta-analysis.Methods: PubMed, Embase, and Web of Science were searched for studies comparing outcomes of total vs subtotal PTX for THPT. A total of 28 studies (n = 1000 patients) met the inclusion criteria.Results: The mean age was 46.5 years and 53% were female. The proportion of females (59% vs 49%) was higher in the total PTX with auto-transplantation cohort (P = .008). Both procedures had similar preoperative calcium and PTH levels. Postoperative and 6-month calcium and PTH were also comparable between groups, except transiently higher post-operative PTH in the total PTX with auto-transplantation cohort (P = .03). Hypercalcemia cure rates were 98%-100% with no difference between surgical techniques (P = .67). Safety profiles were comparable and low.Conclusions: Total PTX with auto-transplantation and subtotal PTX yield similar efficacy and safety for THPT, with no significant differences in cure rates, recurrence, complications, or biochemical control.

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治疗三级甲状旁腺功能亢进症的甲状旁腺次全切除术与全切除术：关于最佳手术方式的系统性文献综述和元分析。

背景：手术是治疗三级甲状旁腺功能亢进症（THPT）的最终选择，然而，最佳手术方法仍不明确。我们的目的是通过系统回顾和荟萃分析，比较全甲状旁腺切除术（PTX）与自体移植术（auto-transplantation）和次全甲状旁腺切除术（subtotal PTX）对甲状旁腺功能亢进症（THPT）的治疗效果：方法：在PubMed、Embase和Web of Science网站上搜索了比较甲状旁腺全切除术与次全切除术治疗THPT疗效的研究。共有28项研究（n = 1000名患者）符合纳入标准：平均年龄为 46.5 岁，53% 为女性。女性比例（59% vs 49%）在全PTX与自体移植队列中更高（P = .008）。两种手术的术前钙和 PTH 水平相似。术后和 6 个月的血钙和 PTH 水平在各组之间也相当，只是在所有 PTX 和自体移植组中，术后 PTH 水平瞬时较高（P = 0.03）。高钙血症治愈率为98%-100%，不同手术技术间无差异（P = .67）。安全性相当低：结论：自体移植全PTX和次全PTX治疗THPT的疗效和安全性相似，在治愈率、复发率、并发症或生化控制方面无显著差异。

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 Surgeon 医学-外科

CiteScore

1.40

自引率

0.00%

发文量

623

期刊介绍： The American Surgeon is a monthly peer-reviewed publication published by the Southeastern Surgical Congress. Its area of concentration is clinical general surgery, as defined by the content areas of the American Board of Surgery: alimentary tract (including bariatric surgery), abdomen and its contents, breast, skin and soft tissue, endocrine system, solid organ transplantation, pediatric surgery, surgical critical care, surgical oncology (including head and neck surgery), trauma and emergency surgery, and vascular surgery.