COMPARATIVE STUDY OF THE SURGICAL TREATMENT OF PRIMARY HYPERPARATHYROIDISM: NON-RADIOGUIDED PARATHYROIDECTOMY VERSUS RADIOGUIDED PARATHYROIDECTOMY IN A CONSECUTIVE SERIES

AUTHORS:
P. Salvador (Pamplona, Spain) , I. Blanco (Pamplona, Spain) , E. Anda (Pamplona, Spain) , C. Erce (Pamplona, Spain) , A. Redondo (Pamplona, Spain) , I. Pérez (Pamplona, Spain) , M. Malo (Pamplona, Spain) , R. Ruiz (Pamplona, Spain) , A. Ariceta (Pamplona, Spain) , O. Aizpurua (Pamplona, Spain)
Background:
Adenoma is the main cause of primary hyperparathyroidism, and surgery its only curative treatment. Norman and Chedda described in 1997 99mTc-MIBI-radioguided minimally invasive parathyroidectomy (RMIP).
Methods:
Observational prospective, single-center study, with a consecutive series of 254 patients with primary hyperparathyroidism, operated on from 2017 to 2022. 258 procedures were performed, 129 non radioguided (NRS) and 129 radioguided (RS) (112 with intravenous 99mTc-MIBI and 17 with ultrasound-guided intralesional 99mTc-MAA injection). Surgery was performed under general anaesthesia, with intraoperative use of gamma-probe and gamma-camera.
Results:
Mean hospital stay was less than 20 hours. There were no significant differences between both groups regarding age, sex, preoperative calcium, preoperative adenoma localization with 99mTc-MIBI-gammagraphy (RS: 89,9%, NRS: 85,3%) and echography (RS: 76%, NRS: 73,6%) or surgical morbidity. Preoperative paratyrin levels were significantly higher in the radioguided surgery and they were correlated with the postoperative weight of adenoma in both groups. Intraoperative localization was 97,7% in both series. There were statistically significant differences favoring radioguided surgery: It allowed to perform minimally invasive surgery (RS: 96,9%, NRS 88,4%; p: 0.015), also in patients with previous neck surgery (RS: 75%, NRS: 28%; p: 0.019) or in ectopic adenomas (RS: 93.3%, NRS: 71.4%; p: 0.012). Mean surgical time was also significantly shorter (RS: 51 min., NRS: 57.78 min.; p: 0.005). Biochemical cure at six months was achieved in RS: 97.6% and NRS: 93.7% (p>0,05).
Conclusions:
RMIP is useful in ectopic adenomas, previous neck surgery, and can avoid intraoperative studies (histology, paratyrin), reducing surgical time and hospital admission, with high cure rates and few complications.