TY - JOUR
T1 - Localization and reoperation results for persistent and recurrent parathyroid carcinoma
AU - Kebebew, E.
AU - Arici, C.
AU - Duh, Q. Y.
AU - Clark, O. H.
AU - Byrd, D.
AU - Latimer, R. G.
AU - O'Connell, T. X.
AU - Schecter, W. P.
AU - Vetto, J. T.
AU - Ryan, J. A.
AU - Norton, J. A.
AU - MacFarlane, J.
AU - Clark,
PY - 2001
Y1 - 2001
N2 - Hypothesis: Reoperation is safe and benefits patients with persistent and recurrent parathyroid carcinoma. Design: Retrospective study. The mean follow-up time was 8.1 years (median, 7 years; range, 1-23 years). Setting: A university tertiary referral center. Patients: Eighteen patients treated for parathyroid carcinoma from 1966 to 1999. Results: The mean serum calcium level was 13.7 mg/dL (3.43 mmol/L), and the parathyroid hormone (PTH) level was 1.6 to 20 times the upper limit of normal. Fourteen of 18 patients had persistent or recurrent parathyroid carcinoma and underwent 54 reoperations (28 at our institution). Mean time to recurrence was 4.8 years (range, 1-20 years). Symptoms of hyperparathyroidism were relieved in 86% of patients who had reoperation (P<.05). Reoperation for parathyroid carcinoma (25 locoregional and 3 distant) significantly reduced and normalized the serum calcium and PTH levels in 75% and 62% of the cases, respectively (P<.001). The preoperative serum calcium level was a significant predictor of postreoperative normalization of the serum calcium level but not extent of initial resection, PTH level, time to recurrence, concordance of localization studies, or patient age and sex (P<.01). Surgical complications consisted of 5 unilateral and 1 bilateral permanent recurrent laryngeal nerve palsies (2 intentionally resected en bloc), 1 transient hypoparathyroidism, 1 wound seroma, and 1 tracheoesophageal fistula. The sensitivity rates of sestamibi scan (n = 14), magnetic resonance imaging (n = 15), computed tomographic scan (n = 6), ultrasound (n = 13), and selective venous catheterization with PTH measurement (n = 6) were 79%, 93%, 67%, 69%, and 83%, respectively. Conclusions: Recurrence is common in patients with parathyroid carcinoma. Patients with this disease should have frequent, lifelong follow-up to ensure early detection of recurrence. Although reoperation for persistent or recurrent parathyroid carcinoma provides significant symptomatic relief and normalizes serum calcium and PTH levels in most patients, it is associated with some morbidity. Localizing studies of parathyroid carcinoma are helpful but do not detect all tumor foci.
AB - Hypothesis: Reoperation is safe and benefits patients with persistent and recurrent parathyroid carcinoma. Design: Retrospective study. The mean follow-up time was 8.1 years (median, 7 years; range, 1-23 years). Setting: A university tertiary referral center. Patients: Eighteen patients treated for parathyroid carcinoma from 1966 to 1999. Results: The mean serum calcium level was 13.7 mg/dL (3.43 mmol/L), and the parathyroid hormone (PTH) level was 1.6 to 20 times the upper limit of normal. Fourteen of 18 patients had persistent or recurrent parathyroid carcinoma and underwent 54 reoperations (28 at our institution). Mean time to recurrence was 4.8 years (range, 1-20 years). Symptoms of hyperparathyroidism were relieved in 86% of patients who had reoperation (P<.05). Reoperation for parathyroid carcinoma (25 locoregional and 3 distant) significantly reduced and normalized the serum calcium and PTH levels in 75% and 62% of the cases, respectively (P<.001). The preoperative serum calcium level was a significant predictor of postreoperative normalization of the serum calcium level but not extent of initial resection, PTH level, time to recurrence, concordance of localization studies, or patient age and sex (P<.01). Surgical complications consisted of 5 unilateral and 1 bilateral permanent recurrent laryngeal nerve palsies (2 intentionally resected en bloc), 1 transient hypoparathyroidism, 1 wound seroma, and 1 tracheoesophageal fistula. The sensitivity rates of sestamibi scan (n = 14), magnetic resonance imaging (n = 15), computed tomographic scan (n = 6), ultrasound (n = 13), and selective venous catheterization with PTH measurement (n = 6) were 79%, 93%, 67%, 69%, and 83%, respectively. Conclusions: Recurrence is common in patients with parathyroid carcinoma. Patients with this disease should have frequent, lifelong follow-up to ensure early detection of recurrence. Although reoperation for persistent or recurrent parathyroid carcinoma provides significant symptomatic relief and normalizes serum calcium and PTH levels in most patients, it is associated with some morbidity. Localizing studies of parathyroid carcinoma are helpful but do not detect all tumor foci.
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U2 - 10.1001/archsurg.136.8.878
DO - 10.1001/archsurg.136.8.878
M3 - Article
C2 - 11485522
AN - SCOPUS:0034909025
SN - 0004-0010
VL - 136
SP - 878
EP - 885
JO - Archives of Surgery
JF - Archives of Surgery
IS - 8
ER -