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Minimally Invasive Approach as Effective as Bilateral Technique for Hyperparathyroidism: Presented at SSO

By Mary Beth Nierengarten

CHICAGO -- March 17, 2008 -- Minimally invasive parathyroidectomy (MIP) is associated with greater improvements in quality of life over time and shorter hospital stay compared with bilateral techniques for treatment of hyperparathyroidism and should be considered the approach of choice for these patients, researchers reported here on March 14 at the Society of Surgical Oncology (SSO) 61st Annual Cancer Symposium.

Although it is well established that quality of life improves after parathyroidectomy, the effect of surgical approach on quality of life during recovery has not been determined, according to investigators from the University of Wisconsin, Madison.

To gain a better understanding of the relative effects of different surgical techniques on quality of life in patients treated surgically for hyperthyroidism, the investigators evaluated measures of quality of life in 146 consecutive patients who underwent parathyroidectomy for hyperthyroidism at their institution. Of these patients, 98 underwent MIP and 48 had bilateral operations.

The most common tumour aetiology in the MIP group was single adenoma (92%) followed by double adenoma (6%). In the bilateral-operations group, hyperplasia was the most common (65%), followed by single and then double adenoma (19% and 17%, respectively).

Surgical outcomes were comparable between the 2 procedures, with cure rates of 100% achieved in both groups after 6 months. Complication rates were also similar between the 2 groups.

However, differences in surgical approach were reported both in length of hospital stay and in quality-of-life measures. Patients treated by MIP had significantly shorter hospital stays than those who underwent bilateral operation (0.2 vs 0.9 days; P < .001).

Quality of life was measured using the 36-item Short Form Health Survey (SF-36), which included 10 scales or categories to measure factors affecting quality of life. The survey was given at baseline, 1 week after surgery, and 1 year after surgery.

At 1 week following surgery, the MIP group had significant improvement in quality of life compared with the bilateral group, reporting improvement in twice as many categories in the SF-36 Health Survey (4 vs 2 scales; P < .05). At 1 year, the MIP group also reported improvements in twice as many categories (8 vs 4 scales; P < .05).

Lead author Joel T. Adler, BA, Medical Student, Section of Endocrine Surgery, University of Wisconsin, Madison, Wisconsin, said that this last finding was particularly interesting and unexpected. "It isn't clear why after a year there was improvement in 8 categories with the minimally invasive approach and only 4 in the bilateral approach. We thought they would be even after 1 year."

Based on the significantly improved quality of life at 1 week and 1 year with the MIP approach, as well as the shortened hospital stay, the authors concluded that the MIP approach should be considered the surgical approach of choice for these patients.

The importance of improving quality of life for patients with hyperthyroidism was highlighted by the finding that all patients, regardless of surgical approach, showed a significant improvement in quality of life after treatment compared with baseline scores.

Adler conducted the study with Herbert Chen, MD, Associate Professor, Division of General Surgery, and Chief, Endocrine Surgery; and Rebecca S. Sippel, MD, Assistant Professor, Division of General Surgery, both of the University of Wisconsin, Madison, Wisconsin.


[Presentation title: The Influence of Surgical Approach on Quality of Life After Parathyroid Surgery. Abstract P49]

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