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Operation for prima...
Operation for primary hyperparathyroidism: the new versus the old order. A randomised controlled trial of preoperative localisation
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Aarum, S (author)
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- Nordenstrom, J (author)
- Karolinska Institutet
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- Reihner, E (author)
- Karolinska Institutet
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- Zedenius, J (author)
- Karolinska Institutet
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- Jacobsson, H (author)
- Karolinska Institutet
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- Danielsson, R (author)
- Karolinska Institutet
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- Backdahl, M (author)
- Karolinska Institutet
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Lindholm, H (author)
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- Wallin, G (author)
- Karolinska Institutet
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- Hamberger, B (author)
- Karolinska Institutet
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- Farnebo, LO (author)
- Karolinska Institutet
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(creator_code:org_t)
- 2016-06-22
- 2007
- English.
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In: Scandinavian journal of surgery : SJS : official organ for the Finnish Surgical Society and the Scandinavian Surgical Society. - : SAGE Publications. - 1457-4969. ; 96:1, s. 26-30
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https://doi.org/10.1...
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Abstract
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- In patients with primary hyperparathyroidism (PHPT), parathyroid imaging is nowadays routinely used for the purpose to perform a focused unilateral minimally invasive operation. The outcome of this new strategy has, however, not been established in randomised trials. Material and Methods: Patients were randomised to either preoperative localisation with sestamibi scintigraphy and ultrasonography (group I) or no preoperative localisation (group II). In group I, a minimally invasive parathyroidectomy was performed in patients in whom both localisation studies were consistent with a single pathological gland, whereas a conventional bilateral neck exploration was performed in cases with negative localisation findings. In group II all patients underwent conventional bilateral neck exploration. Primary outcome measure was normocalcaemia at 6 months postoperatively. Results: In the preoperative localisation group (group I) 23/50 (46%) of the patients could be operated on with the focused operation whereas 26/50 (52%) were operated on by bilateral neck exploration. All patients in the no localisation group (group II; n=50) were operated on with the intended bilateral neck operation. Normocalcaemia was obtained in 96% and 94% in group I and II, respectively. Total (localisation and operative) costs were 21% higher in group I. Conclusions: Routine preoperative localisation, with the intention to perform minimally invasive parathyroidectomy, is not cost effective if concordant results of scintigraphy and ultrasonography are a prerequisite for the focused operation. Less than half of the patients were successfully managed with this strategy, at a higher cost and without obtaining a more favourable clinical outcome.
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- By the author/editor
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Aarum, S
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Nordenstrom, J
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Reihner, E
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Zedenius, J
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Jacobsson, H
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Danielsson, R
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show more...
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Backdahl, M
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Lindholm, H
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Wallin, G
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Hamberger, B
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Farnebo, LO
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show less...
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Scandinavian jou ...
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Scandinavian Jou ...
- By the university
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Karolinska Institutet