Third Department of Surgery, Attikon University Hospital, National and Kapodistrian University of Athens Medical School, Chaidari, Greece.
Third Department of Surgery, Attikon University Hospital, National and Kapodistrian University of Athens Medical School, Chaidari, Greece.
Surgery. 2021 Feb;169(2):302-310. doi: 10.1016/j.surg.2020.08.021. Epub 2020 Sep 30.
Hyperparathyroidism is an almost universal feature of multiple endocrine neoplasia type 1 syndrome. We present a systematic review and meta-analysis of the postoperative outcomes of patients undergoing initial operative treatment of primary hyperparathyroidism complicating multiple endocrine neoplasia 1.
A comprehensive literature search was performed with a priori defined exclusion criteria for studies comparing total parathyroidectomy, subtotal parathyroidectomy, and less than subtotal parathyroidectomy.
Twenty-one studies incorporating 1,131 patients (272 undergoing total parathyroidectomy, 510 subtotal parathyroidectomy, and 349 less than subtotal parathyroidectomy) were identified. Pooled results revealed increased risk for long-term hypoparathyroidism in total parathyroidectomy patients (relative risk 1.61; 95% confidence interval, 1.12-2.31; P = .009) versus those undergoing subtotal parathyroidectomy. In the less than subtotal parathyroidectomy or subtotal parathyroidectomy comparison group, a greater risk for recurrence of hyperparathyroidism (relative risk 1.37; 95% confidence interval, 1.05-1.79; P = .02), persistence of hyperparathyroidism (relative risk 2.26; 95% confidence interval, 1.49-3.41; P = .0001), and reoperation for hyperparathyroidism (relative risk 2.48; 95% confidence interval, 1.65-3.73; P < .0001) was noted for less than subtotal parathyroidectomy patients, albeit with lesser risk for long-term for hypoparathyroidism (relative risk 0.47; 95% confidence interval, 0.29-0.75; P = .002).
Subtotal parathyroidectomy compares favorably to total parathyroidectomy, exhibiting similar recurrence and persistence rates with a decreased propensity for long-term postoperative hypoparathyroidism. The benefit of the decreased risk of hypoparathyroidism in less than subtotal parathyroidectomy is negated by the increase in the risk for recurrence, persistence, and reoperation. Future studies evaluating the performance of less than subtotal parathyroidectomy in specific multiple endocrine neoplasia 1 phenotypes should be pursued in an effort to delineate a patient-tailored, operative approach that optimizes long-term outcomes.
甲状旁腺功能亢进症是多发性内分泌腺瘤 1 型综合征的一个普遍特征。我们对合并多发性内分泌腺瘤 1 的原发性甲状旁腺功能亢进症患者进行初次手术治疗的术后结果进行了系统回顾和荟萃分析。
采用前瞻性定义的排除标准，对比较甲状旁腺全切除术、甲状旁腺次全切除术和不完全甲状旁腺切除术的研究进行了全面的文献检索。
共纳入 21 项研究，纳入 1131 例患者（272 例接受甲状旁腺全切除术，510 例接受甲状旁腺次全切除术，349 例接受不完全甲状旁腺切除术）。汇总结果显示，甲状旁腺全切除术患者发生长期甲状旁腺功能减退的风险增加（相对风险 1.61；95%置信区间，1.12-2.31；P =.009），与接受甲状旁腺次全切除术的患者相比。在不完全甲状旁腺切除术或甲状旁腺次全切除术比较组中，甲状旁腺功能亢进复发的风险更高（相对风险 1.37；95%置信区间，1.05-1.79；P =.02），甲状旁腺功能亢进持续存在的风险更高（相对风险 2.26；95%置信区间，1.49-3.41；P =.0001），甲状旁腺功能亢进需要再次手术的风险更高（相对风险 2.48；95%置信区间，1.65-3.73；P <.0001），但甲状旁腺功能减退的长期风险较低（相对风险 0.47；95%置信区间，0.29-0.75；P =.002）。
甲状旁腺次全切除术与甲状旁腺全切除术相比具有优势，其复发和持续率相似，但术后长期甲状旁腺功能减退的倾向降低。不完全甲状旁腺切除术降低甲状旁腺功能减退风险的益处被复发、持续和再次手术的风险增加所抵消。未来应进行评估特定多发性内分泌腺瘤 1 表型中不完全甲状旁腺切除术表现的研究，以努力确定一种优化长期结果的个体化、手术方法。
