Results of Limited Parathyroidectomy Guided by QPTH

Since 1993, in our institution, exploration and parathyroid resection have been guided exclusively by hormone dynamics using a rapid ICMA point of care assay. Bilateral neck exploration is no longer performed as a standard procedure and is done only when indicated by QPTH or when a preoperative localization study has initially guided the surgeon to the incorrect side of the neck. From September 1993 until July 2002, 403 consecutive patients with SPHPT were operated on. Of these, 401 patients had the intraoperative hormone assay used during their parathyroidectomy. Two patients were excluded because technical problems made the assay unavailable. All patients had total serum calcium levels measured within 1 or 2 days postoperatively, and then a designed follow-up was sought, with measurement of total serum calcium and PTH levels at 2 months, 6 months, and yearly intervals. Definitions used with this data analysis are as follows:

Operative success is considered when a patient has normal or low calcium levels for at least 6 months after parathyroidectomy.

Operative failure is defined as persistent hypercalcemia and elevated PTH levels occurring within 6 months of parathyroidectomy.

Recurrent disease is defined as hypercalcemia and high PTH levels occurring later than 6 months following a successful parathyroidectomy.

MGD is considered the presence of two or more hyperfunctioning glands at the time of parathyroidectomy. Recurrent HPT after single gland resection is not considered MGD.

Out of 401 consecutive patients with SPHPT undergoing parathyroidectomy (359 initial and 42 reoperations), 391 had normal or low calcium levels in the first days after surgery, with 10 patients (5 initial and 5 reoperations) continuing with persistent hypercalcemia. Since all the resections were guided by hormone dynamics instead of the surgeon's judgment of gland size, 97% patients were successfully treated with only one gland excised. Twelve patients with MGD had the QPTH and criterion pointing out the presence of additional hyperfunctioning gland(s) at the time of the surgery, whereas in two patients the QPTH failed to identify MGD.

To evaluate operative success and the accuracy of the intraoperative hormone assay using our criterion, results are reported in all patients followed for 6 months or longer, including all known operative failures in the immediate postoperative period.

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