Mediastinal hyperfunctioning parathyroids: incidence, evolving treatment, and outcome - 22/08/11
Corresponding author. Sylvester Comprehensive Cancer Center, Department of Surgery (M-875), 1475 N.W. 12th Ave, Room 3550, Miami, FL 33136. Tel.: +1-305-243-4211 (ext. 3); fax: +1-305-243-4221.Abstract |
Background |
The evaluation and treatment of hyperfunctioning mediastinal parathyroid gland(s) (MPG) is evolving. This study reports our overall experience with MPG in a tertiary referral center.
Methods |
A prospective database of 922 patients undergoing parathyroidectomy by 2 surgeons from 1982 to 2005 was reviewed.
Results |
Thirty-two of 922 (3.5%) patients had MPG. Nine (28%) patients had a prior failed parathyroidectomy. Sestamibi and computed tomography scans were correctly positive in 24/28 (86%) and 6/7 (86%) patients, respectively. MPGs were removed via cervical approach in 22 (69%). Eleven of 22 patients had a focused cervical approach. Nine MPGs required a limited sternotomy (n = 3) or a successful radioguided video-assisted thoracoscopic approach (VATS, n = 4) for removal. Two VATS were converted to a full sternotomy. One patient refused surgery. All patients who required sternotomy/VATS had MPGs caudal to the innominate vein. Twenty-nine of 31(94%) patients were cured. Two are stable on calcimimetics. One patient has permanent hypoparathyroidism.
Conclusions |
Most MPGs can be removed through a cervical approach. Preoperative Sestamibi and computed tomography scans can help the surgeon plan the best initial surgical approach. Those below the innominate vein require a thoracic procedure, preferably a radioguided probe-assisted thoracoscopic resection with intraoperative parathyroid hormone (ioPTH). An alternative to surgical removal is medical treatment.
Le texte complet de cet article est disponible en PDF.Keywords : Mediastinal, Parathyroid, Thoracoscopy, Radioguided, Parathyroidectomy, Sternotomy
Plan
Vol 194 - N° 1
P. 53-56 - juillet 2007 Retour au numéro
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