PMID- 21713580
OWN - NLM
STAT- MEDLINE
DCOM- 20111223
LR  - 20211020
IS  - 1432-2323 (Electronic)
IS  - 0364-2313 (Linking)
VI  - 35
IP  - 9
DP  - 2011 Sep
TI  - The optimal surgical treatment for primary hyperparathyroidism in MEN1 patients: 
      a systematic review.
PG  - 1993-2005
LID - 10.1007/s00268-011-1068-9 [doi]
AB  - BACKGROUND: The optimal surgical approach for patients with primary 
      hyperparathyroidism (pHPT) and multiple endocrine neoplasia 1 (MEN1) is 
      controversial. We sought to determine the optimal type of surgery for pHPT in 
      MEN1. METHODS: We collected data on clinical presentation, surgery, and follow-up 
      for MEN1 patients with pHPT at the University Medical Center Utrecht and 
      affiliated hospitals between 1967 and 2008. Furthermore, we performed a 
      systematic review of the literature and meta-analysis. Surgical procedures were 
      classified into less than subtotal (<SPTX) versus subtotal (SPTX) and total 
      parathyroidectomy (TPTX). RESULTS: Fifty-two patients underwent primary surgery 
      for pHPT, of which 29 had <SPTX, 17 SPTX, and 6 TPTX. Recurrent pHPT was most 
      frequent after SPTX (65%) followed by <SPTX (59%). Persistent disease was most 
      frequent after <SPTX (31%). Time to recurrence was 61 months longer after SPTX 
      than after <SPTX. Although recurrent pHPT was not seen after TPTX, permanent 
      hypoparathyroidism developed in 67% of these patients. The meta-analysis showed 
      that after SPTX and TPTX, patients had the lowest risk of persistent and 
      recurrent pHPT. TPTX had the highest risk of permanent hypoparathyroidism. Large 
      noncomparative studies showed a low recurrence rate after SPTX and TPTX. 
      CONCLUSION: We believe that SPTX is the best surgical therapy for pHPT in MEN1. 
      MEN1 patients with pHPT should not be treated with <SPTX because of the 
      unacceptable high rate of recurrent and persistent pHPT. Additionally, a 
      thymectomy should routinely be performed in these patients.
FAU - Schreinemakers, Jennifer M J
AU  - Schreinemakers JM
AD  - Department of Surgery, University Medical Center Utrecht, Heidelberglaan 100, 
      3584CX, Utrecht, The Netherlands.
FAU - Pieterman, Carolina R C
AU  - Pieterman CR
FAU - Scholten, Anouk
AU  - Scholten A
FAU - Vriens, Menno R
AU  - Vriens MR
FAU - Valk, Gerlof D
AU  - Valk GD
FAU - Rinkes, Inne H M Borel
AU  - Rinkes IH
LA  - eng
PT  - Journal Article
PT  - Meta-Analysis
PT  - Research Support, Non-U.S. Gov't
PT  - Review
PT  - Systematic Review
PL  - United States
TA  - World J Surg
JT  - World journal of surgery
JID - 7704052
SB  - IM
MH  - Adult
MH  - Cohort Studies
MH  - Comorbidity
MH  - Databases, Factual
MH  - Female
MH  - Follow-Up Studies
MH  - Humans
MH  - Hyperparathyroidism, Primary/diagnosis/*epidemiology/*surgery
MH  - Male
MH  - Middle Aged
MH  - Multiple Endocrine Neoplasia Type 1/diagnosis/*epidemiology/*surgery
MH  - Parathyroidectomy/*adverse effects/methods
MH  - Postoperative Complications/epidemiology/physiopathology
MH  - Reoperation/statistics & numerical data
MH  - Risk Assessment
MH  - Severity of Illness Index
MH  - Treatment Outcome
MH  - Young Adult
EDAT- 2011/06/30 06:00
MHDA- 2011/12/24 06:00
CRDT- 2011/06/30 06:00
PHST- 2011/06/30 06:00 [entrez]
PHST- 2011/06/30 06:00 [pubmed]
PHST- 2011/12/24 06:00 [medline]
AID - 10.1007/s00268-011-1068-9 [doi]
PST - ppublish
SO  - World J Surg. 2011 Sep;35(9):1993-2005. doi: 10.1007/s00268-011-1068-9.