Results of a Fifteen-Year Follow-up Program in Patients Operated with Unilateral Neck Exploration for Primary Hyperparathyroidism.

BACKGROUND

Since the introduction of unilateral parathyroidectomy for primary hyperparathyroidism (pHPT) it has been debated wherever this approach is associated with greater long-term risk for recurrence compared to bilateral neck exploration.

METHODS

This is a prospective study based on a structured 15-year follow-up program in patients with non-hereditary, sporadic pHPT, undergoing first time surgery with unilateral or focused neck exploration (unilateral procedures), with the use of intraoperative PTH (iOPTH) between 1989 and 2010.

RESULTS

292 patients were analyzed. The median age of the patients was 66 years [interquartile range (IQR) 57-75], and 234 (80.4%) were female. The median preoperative level of total calcium was 2.74 mmol/L (IQR 2.63-2.85 mmol/L) and the median PTH level was 10 pmol/L (IQR 7.4-14 pmol/L). The median follow-up time was 5 years (IQR 1-10 years). Some 275 patients were followed for 1 year (94.2%/275 person-years/5 patients deceased), 164 for 5 years (56.2%/820 person-years/31 patients deceased), 70 for 10 years (24.0%/700 patient-years/57 patients deceased) and 51 (17.5%/765 patient-years/69 patients deceased) for 15 years after surgery. Three patients (1.1%) had signs of persistent disease. One patient recurred in pHPT at 5 years postoperatively during 15 years of follow-up. Histopathology indicated solitary parathyroid adenoma at primary surgery.

CONCLUSION

Patients with pHPT operated with unilateral procedures and iOPTH, had a low risk for long-term recurrence during a 15 years follow-up program.