Long-term outcomes and prognostic factors following microwave ablation vs surgical resection for primary hyperparathyroidism.

OBJECTIVE

To compare the long-term efficacy and safety of microwave ablation (MWA) vs surgical resection (SR) in patients with primary hyperparathyroidism (PHPT) over five years.

MATERIALS AND

METHODS

This retrospective study evaluated 172 consecutive patients with PHPT (88 underwent MWA, 84 underwent SR) from 2015 to 2025. The median follow-up was 70.7 months (interquartile range [IQR], 42.6-96.3) in the MWA group and 77.7 months (IQR, 56.5-113.8) in the SR group. Primary outcomes included first-treatment success rate (biochemical normalization after a single procedure without additional interventions), cure rate, and long-term remission rate. Clinical, laboratory, and imaging parameters were analyzed to identify prognostic indicators. Multivariable regression adjusted for key baseline variables.

RESULTS

No significant differences were observed in overall or 1-, 3-, and 5-year long-term remission rates (all p > 0.05) between MWA and SR groups (5-year rate, 77.2% vs 83.1%, log-rank p = 0.78). After adjustment, treatment modality was not associated with cure rate (odds ratio [OR], 1.92; 95% confidence interval [CI], 0.59-6.28; p = 0.28) or long-term remission (hazard ratio [HR], 0.79; 95% CI: 0.18-3.53; p = 0.75). A single parathyroid nodule predicted cure (OR, 3.70; 95% CI: 1.02-3.49; p = 0.048), while higher serum creatinine predicted remission loss (HR, 1.05; 95% CI: 1.01-1.09; p = 0.02). Complication rates were comparable between groups (6.8% vs 3.6%, p = 0.30).

CONCLUSION

MWA provides long-term efficacy comparable to SR for PHPT over five years. Solitary parathyroid nodules and normal renal function are associated with better outcomes regardless of treatment modality.

KEY POINTS: Question Can MWA achieve long-term efficacy and safety comparable to SR in patients with PHPT? Findings Five-year remission was similar between MWA and SR = 0.78); major complication rates also did not differ. Solitary nodules predicted cure, while elevated creatinine was linked to remission loss. Clinical relevance MWA offers a minimally invasive alternative to SR in selected patients with PHPT, providing comparable five-year biochemical remission with a similar safety profile.