Analysis of reoperation for primary hyperparathyroidism (report of 11 cases)_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

 HU Lin ¹ , CUI Aimin ¹ , BAI Nan ¹ , ZHANG Ziqin ¹ , SONG Lei ² , ZHANG Qiang ² , WANG Yanbin ²

1. Department of General Surgery, Beijing Jishuitan Hospital, The 4th Medical College of Peking University, Beijing 100096, P. R. China;
2. Department of Thoracic Surgery, Beijing Jishuitan Hospital, The 4th Medical College of Peking University, Beijing 100035, P. R. China;

Corresponding author：

HU Lin, Email: foxfoxhl@hotmail.com

Keywords：

primary hyperparathyroidism; parathyroid hormone; ⁹⁹Tc^m-MIBI; reoperation

DOI：

10.7507/1007-9424.201707112

Video：

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Objective To analysis causes of reoperation for primary hyperparathyroidism and its clinical characteristics. Method The clinical data of the patients with primary hyperparathyroidism who had undergone reoperation from January 1993 to May 2017 were retrospectively analyzed. Results A total of 11 patients underwent reoperation were collected in the 226 patients with primary hyperparathyroidism. Of the 11 cases, 8 cases underwent twice operations, 2 cases underwent thrice operations, 1 case underwent quintic operation. After the initial operation, 3 cases were persistent diseases and 7 cases were recurrent diseases, 1 patient was not defined as the persistent or recurrent disease. The main clinical manifestations before the reoperation were fatigue, pain in joints, bones, or muscle. The reasons for reoperation included 3 cases of ectopic parathyroid lesions, 3 cases of recurrent parathyroid carcinomas, 1 case of enlarged operation extent for parathyroid carcinoma, 2 cases of regrowth of double parathyroid aedomas, 1 case of missing adenoma, 1 case of parathyroid hyperplasia. Among the location examinations, the ⁹⁹Tc^m-MIBI was most sensitivity (8/9). Eight cases were received reoperation on the original incision, and the remaining 3 ectopic parathyroid lesions on the new incision. After the reoperation, 2 patients were lost of follow-up, 1 patient died, and the remaining 8 patients had no recurrences during follow-up period. Conclusion A comprehensive approach with multiple imageology examinations which attribute to accurate location of lesions, experienced surgeons and well knowledge of parathyroid anatomy and embryology help to descend reoperation ratio and improve success rate of reoperation.

Citation： HU Lin, CUI Aimin, BAI Nan, ZHANG Ziqin, SONG Lei, ZHANG Qiang, WANG Yanbin. Analysis of reoperation for primary hyperparathyroidism (report of 11 cases). CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2018, 25(2): 178-183. doi: 10.7507/1007-9424.201707112 Copy

1.	Udelsman R. Six hundred fifty-six consecutive explorations for primary hyperparathyroidism. Ann Surg, 2002, 235(5): 665-672.
2.	Vojvodich SM, Lampe HB. Imaging and surgery in hyperparathyroidism: a 10-year review. J Otolaryngol, 1996, 25(2): 126-129.
3.	Gaz RD, Doubler PB, Wang CA. The management of 50 unusual hyperfunctioning parathyroid glands. Surgery, 1987, 102(6): 949-957.
4.	Mariette C, Pellissier L, Combemale F, et al. Reoperation for persistent or recurrent primary hyperparathyroidism. Langenbecks Arch Surg, 1998, 383(2): 174-179.
5.	Albuja-Cruz MB, Allan BJ, Parikh PP, et al. Efficacy of localization studies and intraoperative parathormone monitoring in the surgical management of hyperfunctioning ectopic parathyroid glands. Surgery, 2013, 154(3): 453-460.
6.	Granberg PO, Johansson G, Lindvall N, et al. Reoperation for primary hyperparathyroidism. Am J Surg, 1982, 143(3): 296-300.
7.	Brennan MF, Marx SJ, Doppman J, et al. Results of reoperation for persistent and recurrent hyperparathyroidism. Ann Surg, 1981, 194(6): 671-676.
8.	al-Fehaily M, Clark OH. Persistent or recurrent primary hyperparathyroidism. Ann Ital Chir, 2003, 74(4): 423-434.
9.	Tezelman S, Shen W, Siperstein AE, et al. Persistent or recurrent hyperparathyroidism in patients with double adenomas. Surgery, 1995, 118(6): 1115-1124.
10.	朱预. 原发性甲状旁腺功能亢进症治疗中的几个问题. 临床外科杂志, 2000, 8(4): 238-240.
11.	Gray SW, Skandalakis JE, Akin JT Jr. Embryological considerations of thyroid surgery: developmental anatomy of the thyroid, parathyroids and the recurrent laryngeal nerve. Am Surg, 1976, 42(9): 621-628.
12.	Phitayakorn R, McHenry CR. Incidence and location of ectopic abnormal parathyroid glands. Am J Surg, 2006, 191(3): 418-423.
13.	Shen W, Düren M, Morita E, et al. Reoperation for persistent or recurrent primary hyperparathyroidism. Arch Surg, 1996, 131(8): 861-869.
14.	Scharpf J, Kyriazidis N, Kamani D, et al. Anatomy and embryology of the parathyroid gland. Oper Techn Otolaryngol-Head Neck Surg, 2016, 27(3): 117-121.
15.	Roy M, Mazeh H, Chen H, et al. Incidence and localization of ectopic parathyroid adenomas in previously unexplored patients. World J Surg, 2013, 37(1): 102-106.
16.	Mendoza V, Ramírez C, Espinoza AE, et al. Characteristics of ectopic parathyroid glands in 145 cases of primary hyperparathyroidism. Endocr Pract, 2010, 16(6): 977-981.
17.	Haciyanli M, Lal G, Morita E, et al. Accuracy of preoperative localization studies and intraoperative parathyroid hormone assay in patients with primary hyperparathyroidism and double adenoma. J Am Coll Surg, 2003, 197(5): 739-746.
18.	Caron NR, Sturgeon C, Clark OH. Persistent and recurrent hyperparathyroidism. Curr Treat Options Oncol, 2004, 5(4): 335-345.
19.	Kebebew E, Arici C, Duh QY, et al. Localization and reoperation results for persistent and recurrent parathyroid carcinoma. Arch Surg, 2001, 136(8): 878-885.
20.	Mundschenk J, Klose S, Lorenz K, D et al. Diagnostic strategies and surgical procedures in persistent or recurrent primary hyperparathyroidism. Exp Clin Endocrinol Diabetes, 1999, 107(6): 331-336.
21.	Rodriquez JM, Tezelman S, Siperstein AE, et al. Localization procedures in patients with persistent or recurrent hyperparathyroidism. Arch Surg, 1994, 129(8): 870-875.
22.	Koslin DB, Adams J, Andersen P, et al. Preoperative evaluation of patients with primary hyperparathyroidism: role of high-resolution ultrasound. Laryngoscope, 1997, 107(9): 1249-1253.
23.	Grant CS, Thompson G, Farley D, et al. Primary hyperparathyroidism surgical management since the introduction of minimally invasive parathyroidectomy: Mayo clinic experience. Arch Surg, 2005, 140(5): 472-478.

1. Udelsman R. Six hundred fifty-six consecutive explorations for primary hyperparathyroidism. Ann Surg, 2002, 235(5): 665-672.
2. Vojvodich SM, Lampe HB. Imaging and surgery in hyperparathyroidism: a 10-year review. J Otolaryngol, 1996, 25(2): 126-129.
3. Gaz RD, Doubler PB, Wang CA. The management of 50 unusual hyperfunctioning parathyroid glands. Surgery, 1987, 102(6): 949-957.
4. Mariette C, Pellissier L, Combemale F, et al. Reoperation for persistent or recurrent primary hyperparathyroidism. Langenbecks Arch Surg, 1998, 383(2): 174-179.
5. Albuja-Cruz MB, Allan BJ, Parikh PP, et al. Efficacy of localization studies and intraoperative parathormone monitoring in the surgical management of hyperfunctioning ectopic parathyroid glands. Surgery, 2013, 154(3): 453-460.
6. Granberg PO, Johansson G, Lindvall N, et al. Reoperation for primary hyperparathyroidism. Am J Surg, 1982, 143(3): 296-300.
7. Brennan MF, Marx SJ, Doppman J, et al. Results of reoperation for persistent and recurrent hyperparathyroidism. Ann Surg, 1981, 194(6): 671-676.
8. al-Fehaily M, Clark OH. Persistent or recurrent primary hyperparathyroidism. Ann Ital Chir, 2003, 74(4): 423-434.
9. Tezelman S, Shen W, Siperstein AE, et al. Persistent or recurrent hyperparathyroidism in patients with double adenomas. Surgery, 1995, 118(6): 1115-1124.
10. 朱预. 原发性甲状旁腺功能亢进症治疗中的几个问题. 临床外科杂志, 2000, 8(4): 238-240.
11. Gray SW, Skandalakis JE, Akin JT Jr. Embryological considerations of thyroid surgery: developmental anatomy of the thyroid, parathyroids and the recurrent laryngeal nerve. Am Surg, 1976, 42(9): 621-628.
12. Phitayakorn R, McHenry CR. Incidence and location of ectopic abnormal parathyroid glands. Am J Surg, 2006, 191(3): 418-423.
13. Shen W, Düren M, Morita E, et al. Reoperation for persistent or recurrent primary hyperparathyroidism. Arch Surg, 1996, 131(8): 861-869.
14. Scharpf J, Kyriazidis N, Kamani D, et al. Anatomy and embryology of the parathyroid gland. Oper Techn Otolaryngol-Head Neck Surg, 2016, 27(3): 117-121.
15. Roy M, Mazeh H, Chen H, et al. Incidence and localization of ectopic parathyroid adenomas in previously unexplored patients. World J Surg, 2013, 37(1): 102-106.
16. Mendoza V, Ramírez C, Espinoza AE, et al. Characteristics of ectopic parathyroid glands in 145 cases of primary hyperparathyroidism. Endocr Pract, 2010, 16(6): 977-981.
17. Haciyanli M, Lal G, Morita E, et al. Accuracy of preoperative localization studies and intraoperative parathyroid hormone assay in patients with primary hyperparathyroidism and double adenoma. J Am Coll Surg, 2003, 197(5): 739-746.
18. Caron NR, Sturgeon C, Clark OH. Persistent and recurrent hyperparathyroidism. Curr Treat Options Oncol, 2004, 5(4): 335-345.
19. Kebebew E, Arici C, Duh QY, et al. Localization and reoperation results for persistent and recurrent parathyroid carcinoma. Arch Surg, 2001, 136(8): 878-885.
20. Mundschenk J, Klose S, Lorenz K, D et al. Diagnostic strategies and surgical procedures in persistent or recurrent primary hyperparathyroidism. Exp Clin Endocrinol Diabetes, 1999, 107(6): 331-336.
21. Rodriquez JM, Tezelman S, Siperstein AE, et al. Localization procedures in patients with persistent or recurrent hyperparathyroidism. Arch Surg, 1994, 129(8): 870-875.
22. Koslin DB, Adams J, Andersen P, et al. Preoperative evaluation of patients with primary hyperparathyroidism: role of high-resolution ultrasound. Laryngoscope, 1997, 107(9): 1249-1253.
23. Grant CS, Thompson G, Farley D, et al. Primary hyperparathyroidism surgical management since the introduction of minimally invasive parathyroidectomy: Mayo clinic experience. Arch Surg, 2005, 140(5): 472-478.

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Analysis of reoperation for primary hyperparathyroidism (report of 11 cases)

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