Outcomes of Limited Parathyroidectomy in Secondary Hyperparathyroidism

OBJECTIVE: To determine the outcomes of unintended limited parathyroidectomy (LPTX; three or less than three glands removed) in patients with secondary hyperparathyroidism (SHPT). STUDY DESIGN: Retrospective cohort study. PLACE AND DURATION OF STUDY: Jiangmen Central Hospital, China, from January 2012 and December 2019. METHODOLOGY: The operative and biochemical outcomes of LPTX with total parathyroidectomy plus auto-transplantation (PTX+AT) among patients with SHPT were compared. Primary outcomes were persistence and time to recurrence. Secondary outcomes were all-cause death and levels of serum parathyroid hormone (PTH), calcium, alkaline phosphatase (ALP), and phosphate measured pre-surgery, on postoperative day 1 (POD1), and one-year post-PTX in patients cured after the initial surgery. RESULTS: Forty-three patients received LPTX, and 78 underwent PTX-AT. Persistent SHPT was more frequent in the LPTX group (p = 0.001). The area under the receiver operating characteristic curve was 0.89 for POD1 PTH (p <0.001). The frequencies of SHPT recurrence and all-cause mortality were not significantly different. One-year postsurgery, PTH, calcium, ALP, and phosphate levels were significantly decreased in both groups, compared with the respective preoperative values (p <0.001, each). CONCLUSION: LPTX resulted in a higher proportion of persistent SHPT. However, more than half of the patients could be cured and achieved satisfactory outcomes. Cured patients who underwent LPTX can be identified according to PTH levels on POD1. KEY WORDS: Limited parathyroidectomy, Secondary hyperparathyroidism, Recurrence, Persistence, All-cause death.