Reoperation for hyperparathyroidism in multiple endocrine neoplasia type 1

Maryann H. Kivlen, David L. Bartlett, Steven K. Libutti, Monica C. Skarulis, Stephen J. Marx, William F. Simonds, Lee S. Weinstein, Robert T. Jensen, J. Andrea McCart, Arpana M. Naik, Karen C. Kranda, Murray F. Brennan, Jeffrey A. Norton, Douglas L. Fraker, H. Richard Alexander

Research output: Contribution to journalArticle

60 Citations (Scopus)

Abstract

Background. Patients with multiple endocrine neoplasia type 1 and hyperparathyroidism often undergo multiple operations because of inadequate initial surgery, presence of supernumerary and ectopic glands, regrowth of remnant glands, or autograft hyperfunction. Management of this patient population is complex. Methods. From January 1975 to December 2000 we performed 94 reoperative parathyroidectomies consisting of 79 neck reexplorations, 12 autograft removals, and 3 median sternotomies in 75 patients. Data were gathered by retrospective chart review and follow-up telephone interviews. Results. Excluding autograft excision, reoperative surgery was successful (normocalcemia longer than 6 months) in 91%; autograft removal was successful in only 58%. With a median follow-up of 59 months, 64% of patients are currently free from hypercalcemia, and this outcome was not influenced by the total number of glands resected. The median time to recurrent hypercalcemia was 125 months. Thirty patients received an autograft after reoperation. The complication rate for all reoperations was 12%, including permanent recurrent laryngeal nerve injury in 2 patients (2.1%). Conclusions. Reoperative parathyroidectomy in patients with multiple endocrine neoplasia type 1 was safe and successful in the majority of patients; however, recurrent hyperparathyroidism is likely to develop in most individuals beyond 10 years of follow-up. The total number of glands accounted for after reoperation is not associated with successful outcome.

Original languageEnglish (US)
Pages (from-to)991-998
Number of pages8
JournalSurgery
Volume130
Issue number6
DOIs
StatePublished - 2001
Externally publishedYes

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Multiple Endocrine Neoplasia Type 1
Hyperparathyroidism
Reoperation
Autografts
Parathyroidectomy
Hypercalcemia
Recurrent Laryngeal Nerve Injuries
Sternotomy
Neck
Interviews

ASJC Scopus subject areas

  • Surgery

Cite this

Kivlen, M. H., Bartlett, D. L., Libutti, S. K., Skarulis, M. C., Marx, S. J., Simonds, W. F., ... Alexander, H. R. (2001). Reoperation for hyperparathyroidism in multiple endocrine neoplasia type 1. Surgery, 130(6), 991-998. https://doi.org/10.1067/msy.2001.118379

Reoperation for hyperparathyroidism in multiple endocrine neoplasia type 1. / Kivlen, Maryann H.; Bartlett, David L.; Libutti, Steven K.; Skarulis, Monica C.; Marx, Stephen J.; Simonds, William F.; Weinstein, Lee S.; Jensen, Robert T.; McCart, J. Andrea; Naik, Arpana M.; Kranda, Karen C.; Brennan, Murray F.; Norton, Jeffrey A.; Fraker, Douglas L.; Alexander, H. Richard.

In: Surgery, Vol. 130, No. 6, 2001, p. 991-998.

Research output: Contribution to journalArticle

Kivlen, MH, Bartlett, DL, Libutti, SK, Skarulis, MC, Marx, SJ, Simonds, WF, Weinstein, LS, Jensen, RT, McCart, JA, Naik, AM, Kranda, KC, Brennan, MF, Norton, JA, Fraker, DL & Alexander, HR 2001, 'Reoperation for hyperparathyroidism in multiple endocrine neoplasia type 1', Surgery, vol. 130, no. 6, pp. 991-998. https://doi.org/10.1067/msy.2001.118379
Kivlen MH, Bartlett DL, Libutti SK, Skarulis MC, Marx SJ, Simonds WF et al. Reoperation for hyperparathyroidism in multiple endocrine neoplasia type 1. Surgery. 2001;130(6):991-998. https://doi.org/10.1067/msy.2001.118379
Kivlen, Maryann H. ; Bartlett, David L. ; Libutti, Steven K. ; Skarulis, Monica C. ; Marx, Stephen J. ; Simonds, William F. ; Weinstein, Lee S. ; Jensen, Robert T. ; McCart, J. Andrea ; Naik, Arpana M. ; Kranda, Karen C. ; Brennan, Murray F. ; Norton, Jeffrey A. ; Fraker, Douglas L. ; Alexander, H. Richard. / Reoperation for hyperparathyroidism in multiple endocrine neoplasia type 1. In: Surgery. 2001 ; Vol. 130, No. 6. pp. 991-998.
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abstract = "Background. Patients with multiple endocrine neoplasia type 1 and hyperparathyroidism often undergo multiple operations because of inadequate initial surgery, presence of supernumerary and ectopic glands, regrowth of remnant glands, or autograft hyperfunction. Management of this patient population is complex. Methods. From January 1975 to December 2000 we performed 94 reoperative parathyroidectomies consisting of 79 neck reexplorations, 12 autograft removals, and 3 median sternotomies in 75 patients. Data were gathered by retrospective chart review and follow-up telephone interviews. Results. Excluding autograft excision, reoperative surgery was successful (normocalcemia longer than 6 months) in 91{\%}; autograft removal was successful in only 58{\%}. With a median follow-up of 59 months, 64{\%} of patients are currently free from hypercalcemia, and this outcome was not influenced by the total number of glands resected. The median time to recurrent hypercalcemia was 125 months. Thirty patients received an autograft after reoperation. The complication rate for all reoperations was 12{\%}, including permanent recurrent laryngeal nerve injury in 2 patients (2.1{\%}). Conclusions. Reoperative parathyroidectomy in patients with multiple endocrine neoplasia type 1 was safe and successful in the majority of patients; however, recurrent hyperparathyroidism is likely to develop in most individuals beyond 10 years of follow-up. The total number of glands accounted for after reoperation is not associated with successful outcome.",
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AU - Kivlen, Maryann H.

AU - Bartlett, David L.

AU - Libutti, Steven K.

AU - Skarulis, Monica C.

AU - Marx, Stephen J.

AU - Simonds, William F.

AU - Weinstein, Lee S.

AU - Jensen, Robert T.

AU - McCart, J. Andrea

AU - Naik, Arpana M.

AU - Kranda, Karen C.

AU - Brennan, Murray F.

AU - Norton, Jeffrey A.

AU - Fraker, Douglas L.

AU - Alexander, H. Richard

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N2 - Background. Patients with multiple endocrine neoplasia type 1 and hyperparathyroidism often undergo multiple operations because of inadequate initial surgery, presence of supernumerary and ectopic glands, regrowth of remnant glands, or autograft hyperfunction. Management of this patient population is complex. Methods. From January 1975 to December 2000 we performed 94 reoperative parathyroidectomies consisting of 79 neck reexplorations, 12 autograft removals, and 3 median sternotomies in 75 patients. Data were gathered by retrospective chart review and follow-up telephone interviews. Results. Excluding autograft excision, reoperative surgery was successful (normocalcemia longer than 6 months) in 91%; autograft removal was successful in only 58%. With a median follow-up of 59 months, 64% of patients are currently free from hypercalcemia, and this outcome was not influenced by the total number of glands resected. The median time to recurrent hypercalcemia was 125 months. Thirty patients received an autograft after reoperation. The complication rate for all reoperations was 12%, including permanent recurrent laryngeal nerve injury in 2 patients (2.1%). Conclusions. Reoperative parathyroidectomy in patients with multiple endocrine neoplasia type 1 was safe and successful in the majority of patients; however, recurrent hyperparathyroidism is likely to develop in most individuals beyond 10 years of follow-up. The total number of glands accounted for after reoperation is not associated with successful outcome.

AB - Background. Patients with multiple endocrine neoplasia type 1 and hyperparathyroidism often undergo multiple operations because of inadequate initial surgery, presence of supernumerary and ectopic glands, regrowth of remnant glands, or autograft hyperfunction. Management of this patient population is complex. Methods. From January 1975 to December 2000 we performed 94 reoperative parathyroidectomies consisting of 79 neck reexplorations, 12 autograft removals, and 3 median sternotomies in 75 patients. Data were gathered by retrospective chart review and follow-up telephone interviews. Results. Excluding autograft excision, reoperative surgery was successful (normocalcemia longer than 6 months) in 91%; autograft removal was successful in only 58%. With a median follow-up of 59 months, 64% of patients are currently free from hypercalcemia, and this outcome was not influenced by the total number of glands resected. The median time to recurrent hypercalcemia was 125 months. Thirty patients received an autograft after reoperation. The complication rate for all reoperations was 12%, including permanent recurrent laryngeal nerve injury in 2 patients (2.1%). Conclusions. Reoperative parathyroidectomy in patients with multiple endocrine neoplasia type 1 was safe and successful in the majority of patients; however, recurrent hyperparathyroidism is likely to develop in most individuals beyond 10 years of follow-up. The total number of glands accounted for after reoperation is not associated with successful outcome.

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