Forearm vs sternocleidomastoid autotransplantation after total parathyroidectomy for secondary hyperparathyroidism: a network meta-analysis and global bibliometric study.

BACKGROUND

Secondary hyperparathyroidism (SHPT) is a common complication in chronic kidney disease (CKD), and parathyroidectomy (PTX) remains the definitive treatment for refractory cases. However, the optimal surgical strategy, particularly regarding the implantation site for autotransplantation, remains uncertain. Total parathyroidectomy with autotransplantation (TPTX + AT) is widely performed, but it is unclear whether forearm autotransplantation (TPTX + ATF) offers advantages over autotransplantation into the sternocleidomastoid muscle (TPTX + ATSCM).

Methods

Using the Web of Science Core Collection (WOSCC), we performed a bibliometric analysis. We then systematically searched PubMed, Embase, the Cochrane Library, and major Chinese databases (CNKI, Wanfang Data, and VIP) from inception to 1 November 2025. We included randomized controlled trials and cohort studies comparing subtotal PTX (SPTX), TPTX, TPTX + ATF, and TPTX + ATSCM. The primary outcomes were SHPT recurrence and postoperative hypocalcemia. Bayesian network meta-analysis (NMA) was conducted to rank the treatments.

RESULTS

Twenty-seven studies involving 6979 patients were included, comprising 2493 patients treated with SPTX, 964 with TPTX, 3359 with TPTX + ATF, and 163 with TPTX + ATSCM. Compared to TPTX, both SPTX and TPTX + ATF showed higher risks of recurrence (OR 3.80, 95% CrI 1.67-10.78; OR 2.66, 95% CrI 1.04-8.33). No significant differences were observed between TPTX + ATF and TPTX + ATSCM with respect to recurrence (OR 0.66, 95% CrI 0.13-3.05) or postoperative hypocalcemia (OR 1.18, 95% CrI 0.18-6.23). Bibliometric analysis revealed global research activity from the United States and China, with stable contributions over the past two decades.

CONCLUSION

Forearm and sternocleidomastoid autotransplantation showed no statistically significant differences in recurrence or postoperative hypocalcemia based on the available evidence.Current evidence does not support a definitive preference for either implantation site, although forearm implantation may remain a reasonable option in settings where graft monitoring and potential reintervention are important considerations. High-quality randomized trials are still needed to confirm these findings.

SYSTEMATIC REVIEW REGISTRATION: https://www.crd.york.ac.uk/PROSPERO/, identifier CRD420251236587.