Publication: Sekonder hiperparatiroidizm nedeni ile yapılan paratiroidektomi ameliyatlarında üç veya daha az paratiroid çıkarılması klinik başarısızlık mıdır?
Abstract
Amaç: Kronik böbrek yetmezliğinde yeterli ve yetersiz paratiroidektomi uygulanan hastalarda klinik ve biyokimyasal sonuçların karşılaştırılması. Gereç ve Yöntemler: Marmara Üniversitesi Meme ve Endokrin Ünitesi'nde ameliyat edilmiş tüm sekonder hiperparatiroidizm hastaları çalışmaya alındı. Hastalar uygulanan ameliyatın yeterliliğine göre iki gruba ayrıldılar: "yeterli" ve "yetersiz" cerrahi grupları. "Yeterli cerrahi" grubunda subtotal ve total paratiroidektomi uygulanan hastalar yer alırken, "yetersiz cerrahi" grubunda ise 3 ve daha az paratiroid bezi çıkarılan hastalar yeraldı. Hastaların demografik bilgileri, ameliyat öncesi klinik bulguları ve biyokimyasal sonuçları (tCa, PTH) kayıt altına alındı. Hastaların ameliyat sonrası aylık kontrollerindeki sonuçlar kayıt altına alındı. Biyokimyasal bulgularda (tCa, PTH, P, ALP) ve klinik semptomlarda iyileşmeler (1 ile 4 arası skorlama sistemine göre) ameliyat öncesi değerler ile hastanın son kontrolündeki değerlerin karşılaştırılması ile değerlendirildi. Çalışmanın primer çıkarımı her iki grup arasında tedavide başarısızlığın (biyokimyasal persistans/rekürrens) karşılaştırılması iken, sekonder çıkarımlar arasında biyokimyasal parametrelerde ve klinik semptomlarda iyileşme düzeyi ve iki grup arasında komplikasyon görülme sıklığının karşılaştırılması yer almaktadır. Bulgular: Çalışmaya sekonder hiperparatiroidizm nedeniyle ameliyat edilmiş 42 hasta alındı. Hastaların 26'sı erkek, 16'sı kadındı. Ortanca yaş 46 idi. Hastaların 40'ında (%95) ameliyat endikasyonu olarak klinik semptomlar gözükürken, 2 hastada (%5) klinik semptom olmamasına karşın biyokimyasal bulgular nedeni ile ameliyat endikasyonu konuldu. Hastaların 22'sine (%52) yeterli operasyon yapılmışken, 20 hasta (%48) yetersiz ameliyat grubunda yer aldı. Ortalama takip süresi 60 [3-244] ay idi. Biyokimyasal persistans /rekürrens belirgin bir şekilde yetersiz ameliyat grubunda daha fazla izlendi (%75'e karşı %36; OR 5,25; %95 CI 1,38-19,93; p=0,012). Ancak klinik semptomlarda iyileşme oranları her iki grupta benzer izlendi. Sonuç: Yetersiz cerrahi grubunda biyokimyasal tedavi başarısızlığı belirgin olarak daha yüksek izlenirken, şaşırtıcı bir şekilde bu grupta klinik semptomlarda düzelme de benzer şekilde yüksek izlenmektedir. Bununla beraber yeterli cerrahi grubunda da biyokimyasal tedavi başarısızlığı uzun dönem takip sonucunda beklenenin üzerinde izlenmektedir.
Objective: To compare the clinical and biochemical outcomes between adequate and inadequate parathyroidectomies in patients with chronic renal failure.Material and Methods: All secondary hyperparathyroidism patients who were previously operated in the Marmara University Hospital Breast and Endocrine Surgery Unit were planned to be included in the study. Patients were divided into two groups according to their extent of surgery: "adequate" and "inadequate" surgery groups. "Adequate surgery" was regarded as either subtotal (3½) or total parathyroidectomy. Removing fewer than 3½ parathyroids was defined as "inadequate surgery." Demographic, preoperative clinical symptoms, and their severity, as well as biochemical (e.g., tCa, PTH) findings, were recorded. Patients were followed monthly. The course of biochemical findings (tCa, PTH, P, ALP) and symptoms was determined by comparing preoperative findings to those at the patient's last follow-up. Primary outcome of the study was treatment failure (biochemical persistence/recurrence) rates in both study cohorts. Secondary outcomes of the study were the levels of biochemical findings and improvement rates of clinical symptoms after parathyroidectomy, as well as complication rates related to the initial surgery in each surgery cohort.Results: Forty-two patients with secondary hyperparathyroidism who underwent parathyroidectomy were included into the study. Twenty-six were male and 16 were female. Median age was 46. Forty (95%) patients had at least one symptom as the indication for surgery, whereas only 2 (5%) patients were asymptomatic, but biochemical findings were the indication. Twenty-two (52%) patients underwent adequate operation, whereas 20 (48%) patients had inadequate operation. Mean follow-up duration after initial parathyroidectomy was 60 [3-244] months. Significantly more patients (n=15; 75%) in the inadequate surgery group had biochemical persistence/recurrence when compared with those (n=8; 36%) who underwent adequate surgery (OR [odds ratio] 5.25; 95% CI 1.38-19.93; p=0.012). However, symptom improvement rates were similar in both adequate and inadequate surgery groups.Conclusion: Although there is high biochemical treatment failure after inadequate parathyroidectomy in patients with renal hyperparathyroidism, clinical symptom improvement rates are also surprisingly high in this patient group. On the other hand, the adequate surgery group also had an increased biochemical failure rate well above expected in longer follow-ups.
Objective: To compare the clinical and biochemical outcomes between adequate and inadequate parathyroidectomies in patients with chronic renal failure.Material and Methods: All secondary hyperparathyroidism patients who were previously operated in the Marmara University Hospital Breast and Endocrine Surgery Unit were planned to be included in the study. Patients were divided into two groups according to their extent of surgery: "adequate" and "inadequate" surgery groups. "Adequate surgery" was regarded as either subtotal (3½) or total parathyroidectomy. Removing fewer than 3½ parathyroids was defined as "inadequate surgery." Demographic, preoperative clinical symptoms, and their severity, as well as biochemical (e.g., tCa, PTH) findings, were recorded. Patients were followed monthly. The course of biochemical findings (tCa, PTH, P, ALP) and symptoms was determined by comparing preoperative findings to those at the patient's last follow-up. Primary outcome of the study was treatment failure (biochemical persistence/recurrence) rates in both study cohorts. Secondary outcomes of the study were the levels of biochemical findings and improvement rates of clinical symptoms after parathyroidectomy, as well as complication rates related to the initial surgery in each surgery cohort.Results: Forty-two patients with secondary hyperparathyroidism who underwent parathyroidectomy were included into the study. Twenty-six were male and 16 were female. Median age was 46. Forty (95%) patients had at least one symptom as the indication for surgery, whereas only 2 (5%) patients were asymptomatic, but biochemical findings were the indication. Twenty-two (52%) patients underwent adequate operation, whereas 20 (48%) patients had inadequate operation. Mean follow-up duration after initial parathyroidectomy was 60 [3-244] months. Significantly more patients (n=15; 75%) in the inadequate surgery group had biochemical persistence/recurrence when compared with those (n=8; 36%) who underwent adequate surgery (OR [odds ratio] 5.25; 95% CI 1.38-19.93; p=0.012). However, symptom improvement rates were similar in both adequate and inadequate surgery groups.Conclusion: Although there is high biochemical treatment failure after inadequate parathyroidectomy in patients with renal hyperparathyroidism, clinical symptom improvement rates are also surprisingly high in this patient group. On the other hand, the adequate surgery group also had an increased biochemical failure rate well above expected in longer follow-ups.