420 Parathyroid surgery outcomes - 2 surgeons outcomes for the past 9 years in a teaching hospital
Jason Kho, Jen Yee Kuan, Paul Turner, Vinutha Shetty- Surgery
Abstract
Aim
The success of parathyroid surgery in hyperparathyroidism is defined by the sustained improvement in calcium levels without the need for re-exploration. Reoperation rate in the United Kingdom currently sits at 1.6%. It has been shown that the need for repeat parathyroid surgery is related to surgeon annual volume. We aimed to review the outcomes of parathyroid surgery for hyperparathyroidism performed by two upper gastrointestinal surgeons experienced in parathyroidectomies.
Methods
Retrospective review of consecutive parathyroidectomy cases performed by VS and PT in a teaching hospital was conducted between April 2013 and December 2022. Data was obtained from local hospital database. Primary outcome was re-exploration within one year of index procedure. Secondary outcomes included methylene blue uptake by adenomas and postoperative vocal cord palsy.
Results
211 parathyroidectomies were performed during the study period. Patient cohort was predominantly female (n=153, 72.2%). Mean age of study population was 57±13 years. Histopathology confirmed 171 (81.0%) parathyroid adenomas, 34 (16.1%) multiglandular hyperplasia and 6 (2.8%) normal glandular tissue. None were malignant adenoma. 4 (1.9%) patients required re-exploration within one year of index procedure, three of which were found to be ectopic adenomas. Preoperative methylene blue infusion was used in all cases to assist identification of adenoma; uptake was evident in 169 (80.1%) cases. 2 (0.9%) patients developed permanent recurrent laryngeal nerve damage, resulting in mild voice hoarseness.
Conclusion
Our dedicated parathyroid service led by experienced surgeons was associated with comparable re-exploration rates and high cure rates. Preoperative methylene blue infusion helps in intraoperative identification of parathyroid glands.