The Journal of clinical endocrinology and metabolism · 2025
Extent of Surgical Resection and Predictors of Outcomes in MEN1-related Hyperparathyroidism: A Systematic Review and Meta-analysis.
СтатьяСистематический обзорМетаанализПоддержка исследования: вне правительства СШАНазвание и аннотация: Перевод в очереди
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Alves Filho Wellington, Filho Francisco Januário Farias Pereira, Morais Valeria Maria Caland, Gonçalves Victor Balbino, Brescia Marília D'Elboux Guimarães, Montenegro Fabio Luiz de Menezes, d'Alva Catarina Brasil, Quidute Ana Rosa Pinto, Studart da Fonseca Marcio Ribeiro
Аннотация
CONTEXT: Primary hyperparathyroidism (PHPT) is the earliest and most frequent manifestation of multiple endocrine neoplasia type 1 (MEN1). The optimal surgical extent remains controversial due to the tradeoff between recurrence and permanent hypoparathyroidism.
OBJECTIVE: To evaluate outcomes of different surgical approaches in MEN1-related PHPT and assess preoperative biochemical predictors through systematic review and meta-analysis.
DATA SOURCES: MEDLINE, PubMed, Embase.com, LILACS, and CENTRAL were searched from inception to April 2025, following PRISMA guidelines (PROSPERO: CRD420251027970).
STUDY SELECTION: We included studies on adult MEN1-related PHPT patients undergoing parathyroidectomy with reported recurrence, hypoparathyroidism, and preoperative biochemical data.
DATA EXTRACTION: Two reviewers independently extracted data and assessed study quality. Random-effects models were used to pool risk ratios (RR) with 95% confidence intervals (CI). Meta-regression evaluated associations with preoperative PTH, calcium, and phosphorus.
DATA SYNTHESIS: Thirteen studies (915 patients) were included. Less-than-subtotal parathyroidectomy (<STPT) had higher recurrence than subtotal parathyroidectomy (STPT) (RR = 1.26; 95% CI: 1.16-1.36) and total parathyroidectomy with autotransplantation (PTX) (RR = 1.35; 95% CI: 1.22-1.49). STPT showed slightly higher recurrence than PTX (RR = 1.12; 95% CI: 1.02-1.24). <STPT had lower hypoparathyroidism than STPT (RR = 0.90; 95% CI: 0.82-0.98) and PTX (RR = 0.76; 95% CI: 0.63-0.90). Grouping < STPT vs STPT/PTX confirmed higher recurrence (RR = 1.23; 95% CI: 1.03-1.46) and lower hypoparathyroidism (RR = 0.86; 95% CI: 0.78-0.96). No significant associations were found for preoperative PTH, calcium, or phosphorus with outcomes.
CONCLUSION: Conservative surgery reduces hypoparathyroidism but increases recurrence. Personalized surgical strategies are essential in MEN1-related PHPT.
OBJECTIVE: To evaluate outcomes of different surgical approaches in MEN1-related PHPT and assess preoperative biochemical predictors through systematic review and meta-analysis.
DATA SOURCES: MEDLINE, PubMed, Embase.com, LILACS, and CENTRAL were searched from inception to April 2025, following PRISMA guidelines (PROSPERO: CRD420251027970).
STUDY SELECTION: We included studies on adult MEN1-related PHPT patients undergoing parathyroidectomy with reported recurrence, hypoparathyroidism, and preoperative biochemical data.
DATA EXTRACTION: Two reviewers independently extracted data and assessed study quality. Random-effects models were used to pool risk ratios (RR) with 95% confidence intervals (CI). Meta-regression evaluated associations with preoperative PTH, calcium, and phosphorus.
DATA SYNTHESIS: Thirteen studies (915 patients) were included. Less-than-subtotal parathyroidectomy (<STPT) had higher recurrence than subtotal parathyroidectomy (STPT) (RR = 1.26; 95% CI: 1.16-1.36) and total parathyroidectomy with autotransplantation (PTX) (RR = 1.35; 95% CI: 1.22-1.49). STPT showed slightly higher recurrence than PTX (RR = 1.12; 95% CI: 1.02-1.24). <STPT had lower hypoparathyroidism than STPT (RR = 0.90; 95% CI: 0.82-0.98) and PTX (RR = 0.76; 95% CI: 0.63-0.90). Grouping < STPT vs STPT/PTX confirmed higher recurrence (RR = 1.23; 95% CI: 1.03-1.46) and lower hypoparathyroidism (RR = 0.86; 95% CI: 0.78-0.96). No significant associations were found for preoperative PTH, calcium, or phosphorus with outcomes.
CONCLUSION: Conservative surgery reduces hypoparathyroidism but increases recurrence. Personalized surgical strategies are essential in MEN1-related PHPT.