Schlosser, Katja and Bartsch, Detlef K. and Diener, Markus K. and Seiler, Christoph M. and Bruckner, Tom and Nies, Christoph and Meyer, Moritz and Neudecker, Jens and Goretzki, Peter E. and Glockzin, Gabriel and Konopke, Ralf and Rothmund, Matthias (2016) Total Parathyroidectomy With Routine Thymectomy and Autotransplantation Versus Total Parathyroidectomy Alone for Secondary Hyperparathyroidism: Results of a Nonconfirmatory Multicenter Prospective Randomized Controlled Pilot Trial. ANNALS OF SURGERY, 264 (5). pp. 745-753. ISSN 0003-4932, 1528-1140
Full text not available from this repository. (Request a copy)Abstract
Objective:This randomized controlled multicenter pilot trial was conducted to find robust estimates for the rates of recurrence of 2 surgical strategies for secondary hyperparathyroidism (SHPT) within 36 months of follow-up.Background:SHPT is a frequent consequence of chronic renal failure. Total parathyroidectomy with autotransplantation (TPTX+AT) and subtotal parathyroidectomy (SPTX) are the standard surgical procedures. Total parathyroidectomy alone (TPTX) might be a good alternative, as morbidity and recurrence rates are low according to small-scale retrospective studies.Methods:The trial was performed as a nonconfirmatory randomized controlled pilot trial with 100 patients on long-term dialysis with otherwise uncontrollable SHPT to generate data on the rate of recurrent disease within a 3-year follow-up period after TPTX or TPTX+AT. Parathyroid hormone (PTH) and calcium levels, recurrent or persistent hyperparathyroidism, parathyroid reoperations, morbidity, and mortality were evaluated during a 3-year follow-up.Results:A total of 52 patients underwent TPTX and 48 TPTX+AT. Patient characteristics, preoperative baseline data, duration of surgery (02:29 vs 02:47hrs, P = 0.17) and mean hospital stay (10 7.1 vs 8 +/- 3.7 days, P = 0.11) did not differ significantly. Persistent SHPT developed in 1 TPTX and 2 TPTX+AT patients. None of the TPTX patients required delayed parathyroid AT to treat permanent hypoparathyroidism. Serum-calcium values were similar (2.1 +/- 0.3 vs 2.1 +/- 0.2, P = 0.95) whereas PTH rose by time in the TPTX+AT group and was significantly higher at the end of follow-up when compared with the TPTX group (31.7 +/- 43.6 vs 98.2 +/- 156.8, P = 0.02). Recurrent SHPT developed in 4 TPTX+AT and none of the TPTX patients.Conclusions:TPTX+AT and TPTX seem to be safe and equally effective for the treatment of otherwise uncontrollable SHPT. TPTX seems to suppress PTH more effectively and showed no recurrences after 3 years. The hypothesis that TPTX is superior to TPTX+AT referring to the rate of recurrent SHPT has to be tested in a large-scale confirmatory trial. Nevertheless, TPTX seems to be a feasible alternative therapeutic option for the surgical treatment of SHPT.
| Item Type: | Article |
|---|---|
| Uncontrolled Keywords: | STAGE RENAL-DISEASE; CHRONIC KIDNEY-DISEASE; HEMODIALYSIS-PATIENTS; SURGICAL-TREATMENT; TERTIARY HYPERPARATHYROIDISM; DIALYSIS PATIENTS; TRENDS; MANAGEMENT; CINACALCET; OUTCOMES; autotransplantation; randomized controlled trial; secondary hyperparathyroidism; total parathyroidectomy |
| Subjects: | 600 Technology > 610 Medical sciences Medicine |
| Divisions: | Medicine > Lehrstuhl für Chirurgie |
| Depositing User: | Dr. Gernot Deinzer |
| Date Deposited: | 24 Apr 2019 07:43 |
| Last Modified: | 24 Apr 2019 07:43 |
| URI: | https://pred.uni-regensburg.de/id/eprint/4056 |
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