Reoperation for parathyroid adenoma: A contemporary experience

Anathea C. Powell, H. Richard Alexander, Richard Chang, Stephen J. Marx, Monica Skarulis, James F. Pingpank, David L. Bartlett, Marybeth Hughes, Lee S. Weinstein, William F. Simonds, Michael F. Collins, Thomas Shawker, Clara C. Chen, James Reynolds, Craig Cochran, Seth M. Steinberg, Steven K. Libutti

Research output: Contribution to journalArticle

32 Citations (Scopus)

Abstract

Background: We reviewed reoperations for persistent or recurrent sporadic parathyroid adenoma to evaluate and compare our current results and outcomes to our previous experience. Methods: From 1996 to 2008, 237 patients with persistent or recurrent hyperparathyroidism after failed operation underwent reoperation. Patients were re-explored with the assistance of non-invasive and sometimes invasive imaging. Results: A missed adenoma was suspected pre-operatively in 163 patients. Reoperation resulted in long-term resolution of hypercalcemia in 92%. Adenomas were in entopic locations in 32%; the most frequent ectopic location was the thymus (20%). Sestamibi scanning and ultrasonography were the most successful non-invasive imaging studies (96% positive predictive value (PPV) and 84% PPV respectively). Forty-four percent of patients had a reoperation based solely on non-invasive imaging. Of the invasive procedures performed, arteriography resulted in the best localization (92% PPV). Permanent recurrent laryngeal nerve injury occurred in 1.8%. Conclusion: Compared to our prior experience (1982-1995), outcomes remained similar (92% resolution of hypercalcemia and 1.8% recurrent nerve injury currently versus 96% and 1.3% previously). Fewer patients received invasive studies for pre-operative localization (56% vs 73%, respectively). The decreased use of invasive imaging is due to technical improvements and greater confidence in the combination of ultrasonography and sestamibi scanning.

Original languageEnglish (US)
Pages (from-to)1144-1155
Number of pages12
JournalSurgery
Volume146
Issue number6
DOIs
StatePublished - Dec 2009
Externally publishedYes

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Parathyroid Neoplasms
Reoperation
Hypercalcemia
Adenoma
Ultrasonography
Recurrent Laryngeal Nerve Injuries
Hyperparathyroidism
Thymus Gland
Angiography
Wounds and Injuries

ASJC Scopus subject areas

  • Surgery

Cite this

Powell, A. C., Alexander, H. R., Chang, R., Marx, S. J., Skarulis, M., Pingpank, J. F., ... Libutti, S. K. (2009). Reoperation for parathyroid adenoma: A contemporary experience. Surgery, 146(6), 1144-1155. https://doi.org/10.1016/j.surg.2009.09.015

Reoperation for parathyroid adenoma : A contemporary experience. / Powell, Anathea C.; Alexander, H. Richard; Chang, Richard; Marx, Stephen J.; Skarulis, Monica; Pingpank, James F.; Bartlett, David L.; Hughes, Marybeth; Weinstein, Lee S.; Simonds, William F.; Collins, Michael F.; Shawker, Thomas; Chen, Clara C.; Reynolds, James; Cochran, Craig; Steinberg, Seth M.; Libutti, Steven K.

In: Surgery, Vol. 146, No. 6, 12.2009, p. 1144-1155.

Research output: Contribution to journalArticle

Powell, AC, Alexander, HR, Chang, R, Marx, SJ, Skarulis, M, Pingpank, JF, Bartlett, DL, Hughes, M, Weinstein, LS, Simonds, WF, Collins, MF, Shawker, T, Chen, CC, Reynolds, J, Cochran, C, Steinberg, SM & Libutti, SK 2009, 'Reoperation for parathyroid adenoma: A contemporary experience', Surgery, vol. 146, no. 6, pp. 1144-1155. https://doi.org/10.1016/j.surg.2009.09.015
Powell AC, Alexander HR, Chang R, Marx SJ, Skarulis M, Pingpank JF et al. Reoperation for parathyroid adenoma: A contemporary experience. Surgery. 2009 Dec;146(6):1144-1155. https://doi.org/10.1016/j.surg.2009.09.015
Powell, Anathea C. ; Alexander, H. Richard ; Chang, Richard ; Marx, Stephen J. ; Skarulis, Monica ; Pingpank, James F. ; Bartlett, David L. ; Hughes, Marybeth ; Weinstein, Lee S. ; Simonds, William F. ; Collins, Michael F. ; Shawker, Thomas ; Chen, Clara C. ; Reynolds, James ; Cochran, Craig ; Steinberg, Seth M. ; Libutti, Steven K. / Reoperation for parathyroid adenoma : A contemporary experience. In: Surgery. 2009 ; Vol. 146, No. 6. pp. 1144-1155.
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abstract = "Background: We reviewed reoperations for persistent or recurrent sporadic parathyroid adenoma to evaluate and compare our current results and outcomes to our previous experience. Methods: From 1996 to 2008, 237 patients with persistent or recurrent hyperparathyroidism after failed operation underwent reoperation. Patients were re-explored with the assistance of non-invasive and sometimes invasive imaging. Results: A missed adenoma was suspected pre-operatively in 163 patients. Reoperation resulted in long-term resolution of hypercalcemia in 92{\%}. Adenomas were in entopic locations in 32{\%}; the most frequent ectopic location was the thymus (20{\%}). Sestamibi scanning and ultrasonography were the most successful non-invasive imaging studies (96{\%} positive predictive value (PPV) and 84{\%} PPV respectively). Forty-four percent of patients had a reoperation based solely on non-invasive imaging. Of the invasive procedures performed, arteriography resulted in the best localization (92{\%} PPV). Permanent recurrent laryngeal nerve injury occurred in 1.8{\%}. Conclusion: Compared to our prior experience (1982-1995), outcomes remained similar (92{\%} resolution of hypercalcemia and 1.8{\%} recurrent nerve injury currently versus 96{\%} and 1.3{\%} previously). Fewer patients received invasive studies for pre-operative localization (56{\%} vs 73{\%}, respectively). The decreased use of invasive imaging is due to technical improvements and greater confidence in the combination of ultrasonography and sestamibi scanning.",
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AU - Bartlett, David L.

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