EXPERIENCE OF SURGICAL TREATMENT OF SECONDARY HYPERPARATHYROIDISM

E. Rozhanskaya; Valeriy Makhutov; Dmitriy Bulgatov; Anastasiya Zharkaya; Ilicheva   Elena; S. Papeshina

doi:10.12737/22938

EXPERIENCE OF SURGICAL TREATMENT OF SECONDARY HYPERPARATHYROIDISM

Published in Acta biomedica scientifica · Volume 1, Issue 4, p. 2 · Pages 29–35 · Rubric: Clinical Medicine

DOI: https://doi.org/10.12737/22938

Received: 30.11.2016 Accepted: 30.11.2016 Published: 30.11.2016 Language of publication: RUS

Authors

E. Rozhanskaya

Valeriy Makhutov

Dmitriy Bulgatov

Anastasiya Zharkaya

et al.

Ilicheva Elena

S. Papeshina

E. Rozhanskaya

Valeriy Makhutov

Academic degree: candidate of medical sciences

Irkutsk Regional Clinical Hospital Head of the Department of Thoracic Surgery · Russian Federation · Irkutsk

Dmitriy Bulgatov

Russian Federation

Anastasiya Zharkaya

Irkutskiy nauchnyy centr hirurgii i travmatologii Russian Federation

Ilicheva Elena

S. Papeshina

ABSTRACT

Surgical treatment of secondary hyperparathyroidism (HPT) in patients having renal replacement therapy (RRT) is a current problem. The aim of our study was to optimize the treatment of secondary HPT based on the comparative analysis of effectiveness of the surgeries with different extents. We conducted a retrospective analysis of the results of surgical treatment of uremic HPT in 34 patients. 36 surgeries were performed including 34primary (16subtotal parathyroidecomies (PTE), 13total parathyroidecomies (total PTEI), 5total parathyroidecomies with central neck dissection and resection of superior mediastinum and superior thymus horns (total PTEII)) and 2repeated surgeries (total PTEII and parathyroidadenomectomy). Gross examination of 134 surgical specimens revealed dyssynchronous pathological changes in parathyroid glands (PTG), normal PTG structure was found in 2cases. Recurrent HPT was found in 3 cases, persistent HPT – in 9cases, hypoparathyroidism – in 5cases after subtotal PTE and in 9 cases after total PTE with autotransplantation (p=0,267). Target values of parathyroid hormone were registered in 8patients, including 4 patients after subtotal PTE and 4 patients after total PTE (p>0,95). Morbidity was similar in all types of surgeries (p>0,5). Analysis of morbidity determined that simultaneous surgery of thyroid gland increased the risk of laryngeal paralysis (р=0,028). The decrease in occurrence of secondary HPT persistence (with the source accessible for removal through cervical approach) at total PTE based on the removal of parathyroid glands of all localizations accessible through cervical approach (including thyroid gland lobes with diagnosed ectopia, central cervical fat pad, superior mediastinum and superior thymus horns) was registered (NNT=4).

KEYWORDS

secondary hyperparathyroidism, parathyroidectomy

1. .BikbovB T, TomilinaNA (2014). Replacement therapy in patients with chronic renal failure in the Russian Feder-ation in 1998-2011years (according to the data from the Russian Registry of Renal Replacement Therapy. Part1) [Zamestitel’naya terapiya bol’nykh s khronicheskoy pochechnoy nedostatochnost’yu v Rossiyskoy Federatsii v 1998-2011 gg. (otchet po dannym Rossiyskogo regis-tra zamestitel’noy pochechnoy terapii. Chast’ pervaya)]. Nefrologiya i dializ, 16(1), 11-127

2. DedovII, MelnichenkoGA (2013). Endocrinology. National Guidelines. Brief Edition [Endokrinologiya. Nat-sional’noe rukovodstvo. Kratkoe izdanie], 752

3. EvmenovaTD, LyaminaLG (2011). Extensive para-thyroidectomy as an effective method for the treatment of secondary hyperparathyroidism [Rasshirennaya parat-ireoidektomiya kak effektivnyy sposob lecheniya vtorich-nogo giperparatireoza]. Vestnik Kuzbasskogo nauchnogo tsentra, (13), 73-74.

4. EgshatyanLV, RozhinskayaLY, KuznetsovNS, KimIV, ArtyomovaAM, MordikAI, PushkinaAV, BorisovVN, ShiloVY , BukhmanAI, RemizovOV, IlyinAV, SazonovaNI, ChernovaTO (2012). Treatment of secondary hyperpara-thyroidism resistant to alphacalcidol in patients having long term hemodialysis therapy [Lechenie vtorichnogo giperparatireoza, refrakternogo k al’fakal’tsidolu, u pat-sientov, poluchayushchikh zamestitel’nuyu pochechnuyu terapiyu programmnym gemodializom]. Endokrinnayakhirurgiya, (2), 27-41

5. ErmolenkoVM, VolginaGV , DobronravovVA , RozhinskayaLY, SmirnovAV, TomilinaNA, ShostkaGD, AnashkinVA, AndrusevAM, VolkovM M, GerasimchukRP, ZemzhenkovAY, DyubanovaGA, StrokovAG, ShiloVY(2010). National guidelines on mineral and bone disor-ders in chronic renal disease kidney (Russian Dialysis Society, 2010, May) [Natsional’nye rekomendatsii po mineral’nym i kostnym narusheniyam pri khronicheskoy bolezni pochek (Rossiyskoe dializnoe obshchestvo, may 2010 g.)]. Nefrologiya i dializ, 13(1), 33-51

6. IlyichevaEA, AyusheevaAV, RozhanskayaEV, Pape-shinaS A, ApkhanovaN.G. (2014). Clinicopathologic cor-relates of renal hyperparathyroidism [Kliniko-morfolog-icheskie paralleli pochechnogo giperparatireoza]. Materi -aly 22-go (24) Rossiyskogo simpoziuma s mezhdunarodnym uchastiem “Endokrinnaya khirurgiya 2003-2014gg”, 166

7. Hyperparathyroidism: Study guide for interns, medical residents, general practitioners, endocrinologists and surgeons [Giperparatireoz: Ucheb-no-metodicheskoe posobie dlya internov, klinicheskikh ordinatorov, vrachey obshchey praktiki, endokrinologov i khirurgov], 132

8. SleptsovIV, ChernikovRA, NovokshonovKY (2012) Surgical treatment of secondary hyperparathyroidism (work of Northwestern Regional Endocrinology Center in 2009-2011) [Khirurgicheskoe lechenie vtorichnogo giperparatireoza (rabota Severo-Zapadnogo regional’nogo endokrinologicheskogo tsentra v 2009-2011 gg.)]. Avail-able at: http://islep.ru/present/sec_hpt2.pdf

9. KalininAP, MaystrenkoNA, VetshevPS (eds.) (2004). Surgical endocrinology: guidelines [Khirurgicheskaya endokrinologiya: rukovodstvo], 960

10. BellamyJ, BenoitG, HiesseC, CharpentierB(1994). Surgical treatment of hyperparathyroidism in renal transplant patients. Prog. Urol., 4(4), 509-515.

11. BonarekH, MervilleP, BonarekM, MoreauK, Mo-relD , AparicioM, PotauxL (1999). Reduced parathyroid functional mass after successful kidney transplantation. Kidney Int., 56(2), 642-649.

12. ConzoG, PernaA, CandelaG, PalazzoA, Parmeg-gianiD , NapolitanoS, EspositoD, CavalloF, DocimoG,SantiniL (2012). Long-term outcomes following “pre-sumed” total parathyroidectomy for secondary hyperpara-thyroidism of chronic kidney disease. G. Chir., 33(11-12), 379-382.

13. DiaconescuMR, GlodM, CosteaI, GrigoroviciM, CovicA, DiaconescuS (2011). Surgical management of renal hyperparathyroidism: a preliminary series report. Chirurgia (Bucur.), 106(1), 51-57.

14. DiaconescuMR, GlodM, CosteaI, GrigoroviciM, DiaconescuS (2011). Total parathyroidectomy without autotransplantation in the management of “refractory” renal hyperparathyroidism. Rev. Med. Chir. Soc. Med. Nat. Iasi., 115(1), 105-110.

15. GagnéER, UreñaP, Leite-SilvaS, ZingraffJ, Chev-alierA, SarfatiE, DubostC, DrüekeTB (1992). Short- and long-term efficacy of total parathyroidectomy with im-mediate autografting compared with subtotal parathy-roidectomy in hemodialysis patients. J. Am. Soc. Nephrol., 3(4), 1008-1017.

16. HamoudaM, Ben DhiaN, AlouiS, GorsaneI,SkhiriH, FrihA, KoobaaJ, DrissN, BouzouitaK, ElmayM (2011). Surgical treatment of secondary hyperparathy-roidism in patients with chronic renal failure. Nephrol. Ther., 7(2), 105-110.

17. HeQ , ZhuangD, ZhengL, FanZ, ZhouP, ZhuJ, DuanS, LiY, GeY, LvZ, CaoL (2014). Total parathy-roidectomy with trace amounts of parathyroid tissue autotransplantation as the treatment of choice for sec-ondary hyperparathyroidism: a single-center experience. BMC Surg., (14), 26

18. KuoLE, WachtelH, KarakousisG, FrakerD, KelzR(2014). Parathyroidectomy in dialysis patients. J. Surg. Res., 190(2), 554-558.

19. MalmaeusJ (1983). Secondary hyperparathy-roidism in chronic renal failure. Scand. J. Urol. Nephrol. Suppl., (70), 1-63.

20. MalmaeusJ, GrimeliusL, JohanssonH, Aker-strömG , LjunghallS (1984). Parathyroid pathology in hyperparathyroidism secondary to chronic renal failure. Scand. J. Urol. Nephrol., 18(2), 157-166.

21. PulgarB D, JaraCA, GonzálezVG, GonzálezDH(2015). Surgical treatment of renal hyperparathyroidism. Experience in 71 patients. Rev. Med. Chil., 143(2 ), 190-196.

22. RothmundM, WagnerPK (1983). Total para-thyroidectomy and autotransplantation of parathyroid tissue for renal hyperparathyroidism. A one- to six-year follow-up. Ann. Surg., 197(1), 7-16.

23. SakmanG, ParsakCK, BalalM, SeydaogluG, ErayIC, SarıtaşG, DemircanO (2014). Outcomes of total parathyroidectomy with autotransplantation versus subtotal parathyroidectomy with routine addition of thymectomy to both groups: single center experience of secondary hyperparathyroidism. Balkan. Med. J., 31(1), 77-82.

24. SchiaffinoE, ZognoC, SchmidC, MangiliF, Can-taboniA (1992). Optical and ultrastructural morphology in hyperparathyroidism during dialysis. Pathologica, 84(1092), 445-458.

25. SchlosserK, SitterH, RothmundM, ZielkeA(2004). Assessing the site of recurrence in patients with secondary hyperparathyroidism by a simplified Casanova autograftectomy test. World J. Surg., 28(6), 583-588.

26. StrackeS, KellerF, SteinbachG, Henne-BrunsD ,WuerlP (2009). Long-term outcome after total parathyroidectomy for the management of secondary hyperparathyroidism. Nephron. Clin. Pract., 111(2 ), 102-109.

27. TkachenkoRP, KurikEG, GubarAS, BelemetsNI (2014). Pathomorphological features of parathyroid gland in secondary and tertiary hyperparathyroidism. Morpho-logia, 8(2), 67-71.

28. TominagaY, MatsuokaS, SatoT, UnoN, GotoN, KatayamaA, HabaT, UchidaK (2007). Clinical features and hyperplastic patterns of parathyroid glands in hemo-dialysis patients with advanced secondary hyperparathy-roidism refractory to maxacalcitol treatment and required parathyroidectomy. Ther. Apher. Dial., 11(4), 266-273.

29. TominagaY, TakagiH, SuzukiH, KondoT (1985). Histopathological study of the parathyroid gland in renal hyperparathyroidism. Nihon Geka Gakkai Zasshi, 86(5), 630-639.

30. TsaiW C, PengYS, YangJY, HsuSP, WuHY, PaiMF, ChangJF , ChenHY (2013). Short-and long-term impact of subtotal parathyroidectomy on the achievement of bone and mineral parameters recommended by clinical practice guidelines in dialysis patients: a 12-year single-center experience. Blood Purif., 36(2), 116-121

31. WangQS, PalnitkarAM (1996). Parfitt para-thyroid cell proliferation in the rat: effect of age and of phosphate administration and recovery. Endocrinology, 137(11), 4558-4562

JATS XML

Editor-in-Chief, editorial board chair

GOST

Rozhanskaya E., Makhutov V. N., Bulgatov D. A., Zharkaya A. V., Ilicheva E., Papeshina S. EXPERIENCE OF SURGICAL TREATMENT OF SECONDARY HYPERPARATHYROIDISM // Acta biomedica scientifica. 2016. no. 4. pp. 29-35. DOI: https://doi.org/10.12737/22938. (Date of access 05.10.2026).

MLA

E. Rozhanskaya, Makhutov V. N., Bulgatov D. A., Zharkaya A. V., Ilicheva E., Papeshina S.. "EXPERIENCE OF SURGICAL TREATMENT OF SECONDARY HYPERPARATHYROIDISM." Acta biomedica scientifica 1.4 (2016): 29-35. DOI: https://doi.org/10.12737/22938.

APA

Rozhanskaya E., Makhutov V. N., Bulgatov D. A., Zharkaya A. V., Ilicheva E., Papeshina S. (2016). EXPERIENCE OF SURGICAL TREATMENT OF SECONDARY HYPERPARATHYROIDISM. Acta biomedica scientifica, 1(4), 29-35. https://doi.org/10.12737/22938

Chicago

E. Rozhanskaya, Makhutov V. N., Bulgatov D. A., Zharkaya A. V., Ilicheva E., Papeshina S.. "EXPERIENCE OF SURGICAL TREATMENT OF SECONDARY HYPERPARATHYROIDISM." Acta biomedica scientifica 1, no. 4 (2016): 29-35. https://doi.org/10.12737/22938.

WIKI

{{cite journal | author = Rozhanskaya E., Makhutov V. N., Bulgatov D. A., Zharkaya A. V., Ilicheva E., Papeshina S. | title = EXPERIENCE OF SURGICAL TREATMENT OF SECONDARY HYPERPARATHYROIDISM | journal = Acta biomedica scientifica | year = 2016 | volume = 1 | issue = 4 | pages = 29-35 | doi = 10.12737/22938 }}

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