Hormones (Athens, Greece) · 2026
How much is enough - surgical extent of initial parathyroidectomy and long-term outcomes in MEN1-related primary hyperparathyroidism.
СтатьяНазвание и аннотация: Перевод пока не подготовлен
Обработка статьи · этапы, ошибки и управление
Загрузка состояния…
Ошибки и ограничения
История · было → стало
Состояние обновляется каждые 5 секунд, пока блок открыт. Процент показывается только там, где известен объём работы. Пауза останавливает продолжение этапа; текущий запрос к источнику может завершиться.
Daskalakis Kosmas, Ntalaperas Konstantinos, Papadopoulou Nektaria, Tsoli Marina, Angelousi Anna, Kassi Eva, Kaltsas Gregory
Аннотация
CONTEXT: Multiple endocrine neoplasia type 1 (MEN1)-associated primary hyperparathyroidism (pHPT) is typically multiglandular, which contributes to both persistent and recurrent disease following surgery. The optimal extent of initial parathyroidectomy in MEN1 remains debated.
OBJECTIVE: To evaluate long-term outcomes of subtotal parathyroidectomy (SPTX) and total parathyroidectomy with autotransplantation (TPTX-AT) versus less-than-subtotal parathyroidectomy (LSPTX) in MEN1-related pHPT, specifically regarding persistence, recurrence, permanent hypoparathyroidism, and need for reoperation.
METHODS: A retrospective cohort study was conducted including 65 MEN1 patients who underwent initial parathyroidectomy and were followed at a single tertiary referral center. Patients were stratified according to surgical extent (LSPTX vs SPTX/TPTX-AT). Recurrence was analyzed only among patients who had documented initial postoperative normocalcemia and evaluable follow-up; Kaplan-Meier curves were constructed for recurrence-free survival. Multivariable Cox regression was applied to identify independent predictors of adverse outcomes.
RESULTS: The median follow-up was 133.1 months (range 2.4-442.2 months). Nineteen patients underwent LSPTX and 46 underwent SPTX/TPTX-AT. Among patients evaluable for recurrence, recurrent pHPT occurred in 13/19 (68.4%) after LSPTX versus 16/45 (35.6%) after SPTX/TPTX-AT (Fisher's exact test, p = .027). Permanent hypoparathyroidism at last follow-up occurred in 2/17 (11.8%) and 10/45 (22.2%), respectively (p = 0.484). Recurrence-free survival was significantly shorter after LSPTX (log-rank p<0.001). In a parsimonious Cox model adjusted for age at surgery, LSPTX remained associated with shorter recurrence-free survival compared with SPTX/TPTX-AT (HR 6.11 (95% CI 2.64-14.17).
CONCLUSION: In MEN1-related pHPT, limited parathyroidectomy (LSPTX) is associated with significantly higher recurrence rates and shorter recurrence-free survival. Although the risk of permanent hypoparathyroidism appeared lower after LSPTX, this difference did not reach statistical significance. These findings support subtotal parathyroidectomy as the preferred initial surgical strategy in most MEN1 patients, while emphasizing lifelong biochemical surveillance.
OBJECTIVE: To evaluate long-term outcomes of subtotal parathyroidectomy (SPTX) and total parathyroidectomy with autotransplantation (TPTX-AT) versus less-than-subtotal parathyroidectomy (LSPTX) in MEN1-related pHPT, specifically regarding persistence, recurrence, permanent hypoparathyroidism, and need for reoperation.
METHODS: A retrospective cohort study was conducted including 65 MEN1 patients who underwent initial parathyroidectomy and were followed at a single tertiary referral center. Patients were stratified according to surgical extent (LSPTX vs SPTX/TPTX-AT). Recurrence was analyzed only among patients who had documented initial postoperative normocalcemia and evaluable follow-up; Kaplan-Meier curves were constructed for recurrence-free survival. Multivariable Cox regression was applied to identify independent predictors of adverse outcomes.
RESULTS: The median follow-up was 133.1 months (range 2.4-442.2 months). Nineteen patients underwent LSPTX and 46 underwent SPTX/TPTX-AT. Among patients evaluable for recurrence, recurrent pHPT occurred in 13/19 (68.4%) after LSPTX versus 16/45 (35.6%) after SPTX/TPTX-AT (Fisher's exact test, p = .027). Permanent hypoparathyroidism at last follow-up occurred in 2/17 (11.8%) and 10/45 (22.2%), respectively (p = 0.484). Recurrence-free survival was significantly shorter after LSPTX (log-rank p<0.001). In a parsimonious Cox model adjusted for age at surgery, LSPTX remained associated with shorter recurrence-free survival compared with SPTX/TPTX-AT (HR 6.11 (95% CI 2.64-14.17).
CONCLUSION: In MEN1-related pHPT, limited parathyroidectomy (LSPTX) is associated with significantly higher recurrence rates and shorter recurrence-free survival. Although the risk of permanent hypoparathyroidism appeared lower after LSPTX, this difference did not reach statistical significance. These findings support subtotal parathyroidectomy as the preferred initial surgical strategy in most MEN1 patients, while emphasizing lifelong biochemical surveillance.