gms | German Medical Science

Background: The number of parathyroidectomies steadily decreased from 36 per year to 15 per year between 2008 (approval of cinacalcet for use in rHPT) and 2012 at our institution. Since 2014, the number is increasing again.

Materials and methods: The perioperative course of parathyroidectomy with or without previous cinacalcet treatment between 2008 and 2015 was retrospectively analyzed. Mean follow-up was 48.2 months (39.7 months with cinacalcet vs. 54.4 months without).

Results: Of 191 patients undergoing 196 parathyreoidectomies, 80 (41%) received cinacalcet. Altogether, 11% were operated for recurrent or persisting hyperparathyreoidism with the majority of primary resections performed in other hospitals.

All patients suffered from chronic kidney disease and most of them were scheduled for kidney transplantation. 54% of patients with cinacalcet at time of parathyreoidectomy have undergone kidney transplantation up to now vs. 64% of patients without cinacalcet. Most patients underwent subtotal PTx (70%). Simultaneous thyroid surgery for various reasons was performed in 47% of cases.

While preoperative calcium was significantly lower in the group with cinacalcet (2.26 vs. 2.41 mmol/l, p=0.0001), postoperative minimum calcium (1.80 vs. 1.92 mmol/l, p=0.40) calcium at discharge (2.21 vs. 2.12 mmol/l, p=0.90) and calcium at 1 year (2.26 vs. 2.24 mmol/l, p=0.67) were similar in both groups.

Preoperative PTH was similar in patients with or without cinacalcet (755 ng/l vs. 742 ng/l), as well as postoperative PTH (49.8 ng/l vs. 42.2 ng/l) and PTH at 1 year (26.9 ng/l vs. 42.1 ng/l).

One year postop, ten patients after primary operation (3.8% with, 6.7% without cinacalcet) showed hyperparathyroidism (PTH>65 ng/l). While at 1 year 14 patients displayed hypercalcemia (> 2.5mmol/l), only four patients presented both PTH > 100 ng/l and calcium > 2.5mmol/l.

Perioperative morbidity was low with four temporary and one persistent recurrent nerve palsy (two with cinacalcet) and three operative revisions for bleeding/seroma (all without cinacalcet). Mortality during follow-up did not differ between the groups (15 vs. 12%) and cardiovascular events were equally distributed.

Conclusion: Patients treated with cinacalcet displayed high preoperative PTH levels despite treatment. Perioperative results, morbidity and mortality were not different from those without cincalcet. Concomitant thyroid disease is frequent in patients with renal hyperparathyroidism and should be diagnosed preoperatively to allow accurate operative planning.