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The Reasons for Failure in Parathyroid Operations

The Reasons for Failure in Parathyroid Operations Abstract • Primary hyperparathyroidism occurs in about 1 in every 700 individuals. We analyzed our experience with 81 patients with persistent or recurrent hyperparathyroidism who were treated at the University of California, San Francisco, and the Veterans Administration Medical Center, San Francisco, from January 1979 through September 1988. In the 89 reoperations performed, the following six reasons or combination of reasons were responsible for the failed initial operation: (1) in 50 patients, there were multiple abnormal glands (30 hyperplastic and 20 second adenoma); (2) in 40 patients, the tumor was located in an ectopic position (22 mediastinal, 9 deep-seated cervical, 7 intrathyroidal, and 2 undescended); (3) in 17 patients, there were supernumerary parathyroid glands; (4) in 12 patients, the abnormal parathyroid glands were found in normal locations and the tumors were missed because of surgeon inexperience; (5) in 4 patients, failure was due to metastatic parathyroid cancer; and (6) in 4 patients, failure was due to errors on frozen section examinations. Preoperative localization studies usually identified the abnormal parathyroid tumor(s) prior to reoperations and were helpful in these patients. Knowledge of the reasons for failed parathyroid operations and the usual and unusual sites where parathyroid tumors are situated as well as a complete exploration should decrease the frequency of failed parathyroid operations. Localization studies are helpful for identifying these often elusive tumors. (Arch Surg. 1989;124:911-915) References 1. Levin KE, Clark OH. Localization of parathyroid glands . Annu Rev Med . 1988;39:29-40.Crossref 2. Clark OH. Hyperparathyroidism . In: Clark OH, ed. Endocrine Surgery of the Thyroid and Parathyroid Glands . St Louis, Mo: CV Mosby Co; 1985:211-228. 3. Pyrah LN, Hodgkinson A, Anderson CK. Primary hyperparathyroidism . BrJSurg . 1966;53:245-316. 4. Levin KE, Gooding GAW, Okerlund MD, et al. Localizing studies in patients with persistent or recurrent hyperparathyroidism . Surgery . 1987; 102:917-925. 5. Wang CA. Parathyroid re-exploration: a clinical and pathological study of 112 cases . Ann Surg . 1977;186:140-145.Crossref 6. Akerstrom G, Malmaeus J, Bergstrom R. Surgical anatomy of human parathyroid glands . Surgery . 1984;95:14-21. 7. Wang CA. The anatomic basis of parathyroid surgery . Ann Surg . 1976;183:271-275.Crossref 8. Thompson NW, Eckhauser FE, Harness JK. The anatomy of primary hyperparathyroidism . Surgery . 1982;92:814-821. 9. Bruining HA, Birkenhager JC, Ong GL, Lamberts SWJ. Causes of failure in operations for hyperparathyroidism . Surgery . 1987;101:562-565. 10. Edis AJ, Purnell DC, van Heerden JA. The undescended parathymus: an occasional cause of failed neck exploration for hyperparathyroidism . Ann Surg . 1979;190:64-68.Crossref 11. Duh QY, Sancho JJ, Clark OH. Parathyroid localization: clinical review . Acta ChirScand . 1987;153:241-254. 12. Brennan MF, Norton JA. Reoperation for persistent and recurrent hyperparathyroidism . Ann Surg . 1985;201:40-44. 13. Clark OH, Okerlund MD, Moss AA, et al. Localization studies in patients with persistent or recurrent hyperparathyroidism . Surgery . 1985;98:1083-1094. http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Archives of Surgery American Medical Association

The Reasons for Failure in Parathyroid Operations

Levin, Kenneth E.; Clark, Orlo H.
Archives of Surgery , Volume 124 (8) – Aug 1, 1989
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References (12)

Publisher
American Medical Association
Copyright
Copyright © 1989 American Medical Association. All Rights Reserved.
ISSN
0004-0010
eISSN
1538-3644
DOI
10.1001/archsurg.1989.01410080041006
Publisher site
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Abstract

Abstract • Primary hyperparathyroidism occurs in about 1 in every 700 individuals. We analyzed our experience with 81 patients with persistent or recurrent hyperparathyroidism who were treated at the University of California, San Francisco, and the Veterans Administration Medical Center, San Francisco, from January 1979 through September 1988. In the 89 reoperations performed, the following six reasons or combination of reasons were responsible for the failed initial operation: (1) in 50 patients, there were multiple abnormal glands (30 hyperplastic and 20 second adenoma); (2) in 40 patients, the tumor was located in an ectopic position (22 mediastinal, 9 deep-seated cervical, 7 intrathyroidal, and 2 undescended); (3) in 17 patients, there were supernumerary parathyroid glands; (4) in 12 patients, the abnormal parathyroid glands were found in normal locations and the tumors were missed because of surgeon inexperience; (5) in 4 patients, failure was due to metastatic parathyroid cancer; and (6) in 4 patients, failure was due to errors on frozen section examinations. Preoperative localization studies usually identified the abnormal parathyroid tumor(s) prior to reoperations and were helpful in these patients. Knowledge of the reasons for failed parathyroid operations and the usual and unusual sites where parathyroid tumors are situated as well as a complete exploration should decrease the frequency of failed parathyroid operations. Localization studies are helpful for identifying these often elusive tumors. (Arch Surg. 1989;124:911-915) References 1. Levin KE, Clark OH. Localization of parathyroid glands . Annu Rev Med . 1988;39:29-40.Crossref 2. Clark OH. Hyperparathyroidism . In: Clark OH, ed. Endocrine Surgery of the Thyroid and Parathyroid Glands . St Louis, Mo: CV Mosby Co; 1985:211-228. 3. Pyrah LN, Hodgkinson A, Anderson CK. Primary hyperparathyroidism . BrJSurg . 1966;53:245-316. 4. Levin KE, Gooding GAW, Okerlund MD, et al. Localizing studies in patients with persistent or recurrent hyperparathyroidism . Surgery . 1987; 102:917-925. 5. Wang CA. Parathyroid re-exploration: a clinical and pathological study of 112 cases . Ann Surg . 1977;186:140-145.Crossref 6. Akerstrom G, Malmaeus J, Bergstrom R. Surgical anatomy of human parathyroid glands . Surgery . 1984;95:14-21. 7. Wang CA. The anatomic basis of parathyroid surgery . Ann Surg . 1976;183:271-275.Crossref 8. Thompson NW, Eckhauser FE, Harness JK. The anatomy of primary hyperparathyroidism . Surgery . 1982;92:814-821. 9. Bruining HA, Birkenhager JC, Ong GL, Lamberts SWJ. Causes of failure in operations for hyperparathyroidism . Surgery . 1987;101:562-565. 10. Edis AJ, Purnell DC, van Heerden JA. The undescended parathymus: an occasional cause of failed neck exploration for hyperparathyroidism . Ann Surg . 1979;190:64-68.Crossref 11. Duh QY, Sancho JJ, Clark OH. Parathyroid localization: clinical review . Acta ChirScand . 1987;153:241-254. 12. Brennan MF, Norton JA. Reoperation for persistent and recurrent hyperparathyroidism . Ann Surg . 1985;201:40-44. 13. Clark OH, Okerlund MD, Moss AA, et al. Localization studies in patients with persistent or recurrent hyperparathyroidism . Surgery . 1985;98:1083-1094.

Journal

Archives of Surgery – American Medical Association

Published: Aug 1, 1989

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