甲状腺疾患と治療のジャーナル
オープンアクセス

概要

The Safety and Efficacy of Surgery for Primary Hyperparathyroidism without Intraoperative Parathyroid Hormone Measurement in Japan

Hiroki Uchida, Yatsuka Hibi, Chikara Kagawa, Yumi Tomiie and Zenichi Morise

Introduction: Primary hyperparathyroidism (PHP) is a curable disease because most patients have only one adenoma and can fully recover after adenoma removal at the location determined by preoperative imaging. However, many Japanese surgeons believe that intraoperative intact PTH measurement (IOPM) is essential to the surgery. Hence, many general surgeons in Japan are unable to perform surgeries for PHP in their local hospitals and must refer the patients to urban high volume centers that have introduced IOPM, even though they are experienced in general surgery and the surgery for PHP is technically simple and related to general surgery. So, we analyzed the relationship of surgical outcomes, with and without IOPM.

Method: Between January 2007 and December 2016, 183 consecutive patients with PHP underwent surgery in our institution. We performed the surgery between 2007 and 2012 without IOPM, and starting from 2013 we performed the surgery with IOPM. We compared and evaluated the cure rate and surgical complications between patients who underwent unilateral neck exploration without IOPM with clear preoperative localization of the affected adenoma, and those who underwent any surgery with IOPM.

Result: There was no significant difference in cure rate between the two groups and there were no surgical complication in either group.

Conclusion: In cases where preoperative imaging is able to clearly localize the affected adenoma and an experienced general or endocrine surgeon performs the surgery, there is no significant difference in overall cure rate and surgical complications with or without IOPM. Though many hospitals in Japan currently do not perform IOPM routinely, our study may encourage many general surgeons to perform the surgery without IOPM.