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Inicio Cirugía Española (English Edition) Radioguided parathyroidectomy: What does it contribute to surgery?
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Original article
Pre-proof, online 23 December 2024
Radioguided parathyroidectomy: What does it contribute to surgery?
Paratiroidectomia radioguiada: ¿qué aporta a la cirugía?
P. Salvador Egeaa, I. Blanco Saizb, E. Anda Apiñánizc, A. Redondo Expósitoa, C. Erce Garcíaa,
Corresponding author
cristina.erce.garcia@navarra.es

Corresponding author.
, I. Pérez Otermind, N. Cruz Vásquezb
a Unidad de Cirugía Endocrina, Servicio de Cirugía General, Hospital Universitario de Navarra, Pamplona, Spain
b Servicio de Medicina Nuclear, Hospital Universitario de Navarra, Pamplona, Spain
c Servicio de Endocrinología, Hospital Universitario de Navarra, Pamplona, Spain
d Servicio de Cirugía General, Hospital Universitario de Navarra, Pamplona, Spain
Article information
Abstract
Objective

To evaluate whether a radioguided approach allows a higher intraoperative detection rate of adenoma and a minimally invasive parathyroidectomy (MIP), with the same or better cure rate of hyperparathyroidism secondary to parathyroid adenoma.

Methods

This was an observational, prospective, single-center study involving 254 consecutive patients with primary hyperparathyroidism, between 2017 and 2022. A total of 258 procedures were performed: 129 non radioguided (NRS) and 129 radioguided (RS) (112 with intravenous 99 mTc- MIBI and 17 with ultrasound-guided intralesional 99 mTc-MAA injection) with an intraoperative gamma probe and gamma camera. Follow-up was performed for at least one year.

Results

There were no differences between the groups in terms of age, sex, preoperative calcium or parathyroid hormone levels, adenoma localization with 99 mTc-MIBI-gammagraphy and ultrasound, and surgical morbidity.

Intraoperative surgical localization was 97.7% in both groups. Statistically significant differences supported RS: It allowed to perform MIP (RS: 96.9%, NRS 88.4%; p = 0.015), also in patients with previous neck surgery (RS: 75%, NRS: 28%; p = 0.019) and with ectopic adenomas (RS: 93.3%, NRS: 71.4%; p = 0.012). The operative time was significantly shorter (RS: 51 min., NRS: 59.79 min.; p = 0.005). There were no significant differences in the postoperative complications between the groups.

Biochemical cure at six months was achieved in RS: 97.7% and NRS: 93.8% (p = 0.12).

Conclusions

Radioguided MIP is useful in ectopic adenomas and in patients with previous cervical surgery and allows a minimally invasive approach more frequently. It is a safe surgery, easily reproducible by an endocrine surgeon and requires usual equipment found in operating rooms.

Keywords:
Primary hyperparathyroidism
Parathyroid
Radioguided
Resumen
Objetivos

Evaluar si un abordaje radioguiado permite una mayor tasa de detección intraoperatoria del adenoma y una paratiroidectomía mínimamente invasiva (PMI), con la misma o mejor tasa de curación del hiperparatiroidismo primario por adenoma paratiroideo.

Metodología

Estudio observacional, prospectivo y unicéntrico con 254 pacientes consecutivos afectos de hiperparatiroidismo primario, entre 2017 y 2022. Se realizaron un total de 258 procedimientos: 129 no radioguiados (CNR) y 129 radioguiados (CR) (112 con 99 mTc- MIBI intravenoso y 17 con inyección intralesional de 99 mTc-MAA) con gammasonda intraoperatoria y gammacámara. Seguimiento postoperatorio durante al menos un año.

Resultados

Sin diferencias entre ambos grupos en cuanto a edad, sexo, niveles preoperatorios de calcio u hormona paratiroidea, localización del adenoma con gammagrafía con 99 mTc-MIBI y ecografía, y morbilidad quirúrgica.

La localización quirúrgica intraoperatoria fue del 97,7% en ambos grupos. Diferencias estadísticamente significativas a favor de CR: Permitió realizar PMI (CR: 96,9%, CNR 88,4%; p = 0,015), también en pacientes con cirugía previa de cuello (CR: 75%, CNR: 28%; p = 0,019) o adenomas ectópicos (CR: 93,3%, CNR: 71,4%; p = 0,012). El tiempo operatorio fue significativamente menor (CR: 51 min., CNR: 59,79 min.; p = 0,005). No hubo diferencias significativas en las complicaciones postoperatorias entre los grupos.

La curación bioquímica se alcanzó en CR: 97,7% y CNR: 93,8% (p = 0,12).

Conclusiones

La cirugía radioguiada es útil en adenomas ectópicos y en pacientes con cirugía cervical previa y permite un abordaje mínimamente invasivo con mayor frecuencia. Es una cirugía segura, fácilmente realizable por un cirujano endocrino y utiliza equipamiento habitual en los quirófanos de cirugía general.

Palabras clave:
Hiperparatiroidismo primario
Paratiroides
Radioguiado

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