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

doi:10.1016/j.surg.2009.09.015

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 journal › Article › peer-review

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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.

Original language	English (US)
Pages (from-to)	1144-1155
Number of pages	12
Journal	Surgery
Volume	146
Issue number	6
DOIs	https://doi.org/10.1016/j.surg.2009.09.015
State	Published - Dec 2009
Externally published	Yes

ASJC Scopus subject areas

Surgery

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Powell, A. C., Alexander, H. R., Chang, R., Marx, S. J., Skarulis, M., Pingpank, J. F., Bartlett, D. L., Hughes, M., Weinstein, L. S., Simonds, W. F., Collins, M. F., Shawker, T., Chen, C. C., Reynolds, J., Cochran, C., Steinberg, S. M., & 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

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

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title = "Reoperation for parathyroid adenoma: A contemporary experience",

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.",

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

year = "2009",

month = dec,

doi = "10.1016/j.surg.2009.09.015",

language = "English (US)",

volume = "146",

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T2 - A contemporary experience

AU - Powell, Anathea C.

AU - Alexander, H. Richard

AU - Chang, Richard

AU - Marx, Stephen J.

AU - Skarulis, Monica

AU - Pingpank, James F.

AU - Bartlett, David L.

AU - Hughes, Marybeth

AU - Weinstein, Lee S.

AU - Simonds, William F.

AU - Collins, Michael F.

AU - Shawker, Thomas

AU - Chen, Clara C.

AU - Reynolds, James

AU - Cochran, Craig

AU - Steinberg, Seth M.

AU - Libutti, Steven K.

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N2 - 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.

AB - 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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Reoperation for parathyroid adenoma: A contemporary experience

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