How long should we follow patients after apparently curative parathyroidectomy?
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 sp...
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| Veröffentlicht in: | Surgery 2017-01, Vol.161 (1), p.54-61 |
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| creator | Lou, Irene, MD Balentine, Courtney, MD, MPH Clarkson, Samuel, BA Schneider, David F., MD, MS Sippel, Rebecca S., MD Chen, Herbert, MD |
| description | 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 10 years after the initial operation, long-term follow-up is essential. |
| doi_str_mv | 10.1016/j.surg.2016.05.049 |
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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.</description><identifier>ISSN: 0039-6060</identifier><identifier>EISSN: 1532-7361</identifier><identifier>DOI: 10.1016/j.surg.2016.05.049</identifier><identifier>PMID: 27863779</identifier><language>eng</language><publisher>United States: Elsevier Inc</publisher><subject>Age Factors ; Aged ; Analysis of Variance ; Cohort Studies ; Databases, Factual ; Female ; Follow-Up Studies ; Humans ; Hyperparathyroidism, Primary - diagnosis ; Hyperparathyroidism, Primary - surgery ; Kaplan-Meier Estimate ; Male ; Middle Aged ; Multivariate Analysis ; Parathyroid Hormone - blood ; Parathyroidectomy - adverse effects ; Parathyroidectomy - methods ; Proportional Hazards Models ; Recurrence ; Retrospective Studies ; Risk Assessment ; Severity of Illness Index ; Sex Factors ; Surgery ; Time Factors</subject><ispartof>Surgery, 2017-01, Vol.161 (1), p.54-61</ispartof><rights>Elsevier Inc.</rights><rights>2016 Elsevier Inc.</rights><rights>Copyright © 2016 Elsevier Inc. All rights reserved.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c510t-def4bcd006ef4b3edaf2a8e763079a38840bd214d46e6a91937b838a868bd7f13</citedby><cites>FETCH-LOGICAL-c510t-def4bcd006ef4b3edaf2a8e763079a38840bd214d46e6a91937b838a868bd7f13</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://dx.doi.org/10.1016/j.surg.2016.05.049$$EHTML$$P50$$Gelsevier$$H</linktohtml><link.rule.ids>230,314,780,784,885,3550,27924,27925,45995</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/27863779$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Lou, Irene, MD</creatorcontrib><creatorcontrib>Balentine, Courtney, MD, MPH</creatorcontrib><creatorcontrib>Clarkson, Samuel, BA</creatorcontrib><creatorcontrib>Schneider, David F., MD, MS</creatorcontrib><creatorcontrib>Sippel, Rebecca S., MD</creatorcontrib><creatorcontrib>Chen, Herbert, MD</creatorcontrib><title>How long should we follow patients after apparently curative parathyroidectomy?</title><title>Surgery</title><addtitle>Surgery</addtitle><description>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.</description><subject>Age Factors</subject><subject>Aged</subject><subject>Analysis of Variance</subject><subject>Cohort Studies</subject><subject>Databases, Factual</subject><subject>Female</subject><subject>Follow-Up Studies</subject><subject>Humans</subject><subject>Hyperparathyroidism, Primary - diagnosis</subject><subject>Hyperparathyroidism, Primary - surgery</subject><subject>Kaplan-Meier Estimate</subject><subject>Male</subject><subject>Middle Aged</subject><subject>Multivariate Analysis</subject><subject>Parathyroid Hormone - blood</subject><subject>Parathyroidectomy - adverse effects</subject><subject>Parathyroidectomy - methods</subject><subject>Proportional Hazards Models</subject><subject>Recurrence</subject><subject>Retrospective Studies</subject><subject>Risk Assessment</subject><subject>Severity of Illness Index</subject><subject>Sex Factors</subject><subject>Surgery</subject><subject>Time Factors</subject><issn>0039-6060</issn><issn>1532-7361</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2017</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp9UsFu1DAUtBCIbgs_wAHlyCXBjh3HllBRVUGLVKkH4Gw59suuF28c7GSr_D2OtlTAgZPHfvPGTzMPoTcEVwQT_n5fpTluqzrjCjcVZvIZ2pCG1mVLOXmONhhTWXLM8Rk6T2mPMZaMiJforG4Fp20rN-j-NjwUPgzbIu3C7G3xAEUfvM-vo54cDFMqdD9BLPQ46pjvfinMHHPtCJmSwW6JwVkwUzgsH1-hF732CV4_nhfo--dP365vy7v7my_XV3elaQieSgs964zFmK-AgtV9rQW0nOJWaioEw52tCbOMA9eSSNp2ggotuOhs2xN6gS5PuuPcHcCaPFjUXo3RHXRcVNBO_V0Z3E5tw1E1hDPZ8Czw7lEghp8zpEkdXDLgvR4gzEkRwUgrayZwptYnqokhpQj90zcEqzUJtVdrEmpNQuFG5SRy09s_B3xq-W19Jnw4ESDbdHQQVTLZbwPWxWymssH9X__yn3bj3eCM9j9ggbQPcxxyAIqoVCusvq67sK4CyRYzyWv6C9HKsh0</recordid><startdate>20170101</startdate><enddate>20170101</enddate><creator>Lou, Irene, MD</creator><creator>Balentine, Courtney, MD, MPH</creator><creator>Clarkson, Samuel, BA</creator><creator>Schneider, David F., MD, MS</creator><creator>Sippel, Rebecca S., MD</creator><creator>Chen, Herbert, MD</creator><general>Elsevier Inc</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope><scope>5PM</scope></search><sort><creationdate>20170101</creationdate><title>How long should we follow patients after apparently curative parathyroidectomy?</title><author>Lou, Irene, MD ; Balentine, Courtney, MD, MPH ; Clarkson, Samuel, BA ; Schneider, David F., MD, MS ; Sippel, Rebecca S., MD ; Chen, Herbert, MD</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c510t-def4bcd006ef4b3edaf2a8e763079a38840bd214d46e6a91937b838a868bd7f13</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2017</creationdate><topic>Age Factors</topic><topic>Aged</topic><topic>Analysis of Variance</topic><topic>Cohort Studies</topic><topic>Databases, Factual</topic><topic>Female</topic><topic>Follow-Up Studies</topic><topic>Humans</topic><topic>Hyperparathyroidism, Primary - diagnosis</topic><topic>Hyperparathyroidism, Primary - surgery</topic><topic>Kaplan-Meier Estimate</topic><topic>Male</topic><topic>Middle Aged</topic><topic>Multivariate Analysis</topic><topic>Parathyroid Hormone - blood</topic><topic>Parathyroidectomy - adverse effects</topic><topic>Parathyroidectomy - methods</topic><topic>Proportional Hazards Models</topic><topic>Recurrence</topic><topic>Retrospective Studies</topic><topic>Risk Assessment</topic><topic>Severity of Illness Index</topic><topic>Sex Factors</topic><topic>Surgery</topic><topic>Time Factors</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Lou, Irene, MD</creatorcontrib><creatorcontrib>Balentine, Courtney, MD, MPH</creatorcontrib><creatorcontrib>Clarkson, Samuel, BA</creatorcontrib><creatorcontrib>Schneider, David F., MD, MS</creatorcontrib><creatorcontrib>Sippel, Rebecca S., MD</creatorcontrib><creatorcontrib>Chen, Herbert, MD</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><collection>PubMed Central (Full Participant titles)</collection><jtitle>Surgery</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Lou, Irene, MD</au><au>Balentine, Courtney, MD, MPH</au><au>Clarkson, Samuel, BA</au><au>Schneider, David F., MD, MS</au><au>Sippel, Rebecca S., MD</au><au>Chen, Herbert, MD</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>How long should we follow patients after apparently curative parathyroidectomy?</atitle><jtitle>Surgery</jtitle><addtitle>Surgery</addtitle><date>2017-01-01</date><risdate>2017</risdate><volume>161</volume><issue>1</issue><spage>54</spage><epage>61</epage><pages>54-61</pages><issn>0039-6060</issn><eissn>1532-7361</eissn><abstract>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.</abstract><cop>United States</cop><pub>Elsevier Inc</pub><pmid>27863779</pmid><doi>10.1016/j.surg.2016.05.049</doi><tpages>8</tpages><oa>free_for_read</oa></addata></record> |
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| subjects | Age Factors Aged Analysis of Variance Cohort Studies Databases, Factual Female Follow-Up Studies Humans Hyperparathyroidism, Primary - diagnosis Hyperparathyroidism, Primary - surgery Kaplan-Meier Estimate Male Middle Aged Multivariate Analysis Parathyroid Hormone - blood Parathyroidectomy - adverse effects Parathyroidectomy - methods Proportional Hazards Models Recurrence Retrospective Studies Risk Assessment Severity of Illness Index Sex Factors Surgery Time Factors |
| title | How long should we follow patients after apparently curative parathyroidectomy? |
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