TY - JOUR
T1 - How long should we follow patients after apparently curative parathyroidectomy?
AU - Lou, Irene
AU - Balentine, Courtney
AU - Clarkson, Samuel
AU - Schneider, David F.
AU - Sippel, Rebecca S.
AU - Chen, Herbert
N1 - Publisher Copyright:
© 2016 Elsevier Inc.
PY - 2017/1/1
Y1 - 2017/1/1
N2 - Background Little is known about the long-term recurrence risk for primary hyperparathyroidism after immediately “curative” parathyroidectomy. This study aimed to evaluate the risk of recurrent hyperparathyroidism in the 10 years after operation. Method We retrospectively identified patients with sporadic primary hyperparathyroidism undergoing initial parathyroidectomy between November 1, 2000 and June 30, 2005. Recurrence was defined as serum calcium >10.2 mg/dL after 6 months from operation. Kaplan-Meier estimates and Cox proportional hazards were used to evaluate disease-free survival and predictors of recurrence. Results We evaluated 196 patients with a 14.8% 10-year recurrence rate. Median time to recurrence was 6.3 years (interquartile range 3.4–10.8 years), and 34.5% of all recurrences were identified >10 years after operation. There was no difference in recurrence between open and minimally invasive operation (P = .448). Double adenomas (P = .006), intraoperative parathyroid hormone drop <70% (P = .015), and young age (P = .032) were predictive of disease recurrence. Multivariable analysis demonstrated that older age was protective against recurrence (hazard ratio 0.97, 95% confidence interval 0.94–0.99, P = .034), while double adenomas (hazard ratio 3.52, 95% confidence interval 1.23–10.08, P = .019) were an independent predictor for recurrence. Conclusion The long-term recurrence rate for sporadic primary hyperparathyroidism after “curative” parathyroidectomy is likely greater than reported. With over one-third of our institutional recurrences at >10 years after the initial operation, long-term follow-up is essential.
AB - Background Little is known about the long-term recurrence risk for primary hyperparathyroidism after immediately “curative” parathyroidectomy. This study aimed to evaluate the risk of recurrent hyperparathyroidism in the 10 years after operation. Method We retrospectively identified patients with sporadic primary hyperparathyroidism undergoing initial parathyroidectomy between November 1, 2000 and June 30, 2005. Recurrence was defined as serum calcium >10.2 mg/dL after 6 months from operation. Kaplan-Meier estimates and Cox proportional hazards were used to evaluate disease-free survival and predictors of recurrence. Results We evaluated 196 patients with a 14.8% 10-year recurrence rate. Median time to recurrence was 6.3 years (interquartile range 3.4–10.8 years), and 34.5% of all recurrences were identified >10 years after operation. There was no difference in recurrence between open and minimally invasive operation (P = .448). Double adenomas (P = .006), intraoperative parathyroid hormone drop <70% (P = .015), and young age (P = .032) were predictive of disease recurrence. Multivariable analysis demonstrated that older age was protective against recurrence (hazard ratio 0.97, 95% confidence interval 0.94–0.99, P = .034), while double adenomas (hazard ratio 3.52, 95% confidence interval 1.23–10.08, P = .019) were an independent predictor for recurrence. Conclusion The long-term recurrence rate for sporadic primary hyperparathyroidism after “curative” parathyroidectomy is likely greater than reported. With over one-third of our institutional recurrences at >10 years after the initial operation, long-term follow-up is essential.
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U2 - 10.1016/j.surg.2016.05.049
DO - 10.1016/j.surg.2016.05.049
M3 - Article
C2 - 27863779
AN - SCOPUS:85006276982
SN - 0039-6060
VL - 161
SP - 54
EP - 61
JO - Surgery (United States)
JF - Surgery (United States)
IS - 1
ER -