• Annals of surgery · Feb 2024

    Recurrence after Surgery for Primary Hyperparathyroidism in 517 Patients with Multiple Endocrine Neoplasia Type 1. An AFCE and GTE study (Association Francophone de Chirurgie Endocrinienne and Groupe d'étude des Tumeurs Endocrines).

    • Nicolas Santucci, Elea Ksiazek, François Pattou, Gregory Baud, Eric Mirallié, Samuel Frey, Christophe Trésallet, Frédéric Sébag, Carole Guérin, Muriel Mathonnet, Niki Christou, Gianluca Donatini, Laurent Brunaud, Sébastien Gaujoux, Fabrice Ménégaux, Haythem Najah, Christine Binquet, Pierre Goudet, and Jean-Christophe Lifante.
    • Department of Digestive and Endocrine Surgery, Dijon University Hospital.
    • Ann. Surg. 2024 Feb 1; 279 (2): 340345340-345.

    ObjectiveTo assess recurrence according to the type of surgery for primary hyperparathyroidism (pHPT) in multiple endocrine neoplasia type 1 ( MEN1 ) patients and to identify the risk factors for recurrence after the initial surgery.BackgroundIn MEN1 patients, pHPT is multiglandular, and the optimal extent of initial parathyroid resection influences the risk of recurrence.MethodsMEN1 patients who underwent initial surgery for pHPT between 1990 and 2019 were included. Persistence and recurrence rates after less than subtotal parathyroidectomy (LTSP) and subtotal parathyroidectomy (STP) were analyzed. Patients with total parathyroidectomy with reimplantation were excluded.ResultsFive hundred seventeen patients underwent their first surgery for pHPT: 178 had LTSP (34.4%) and 339 STP (65.6%). The recurrence rate was significantly higher after LTSP (68.5%) than STP (45%) ( P < 0.001). The median time to recurrence after pHPT surgery was significantly shorter after LTSP than after STP: 4.25 (1.2-7.1) versus 7.2 (3.9-10.1) years ( P < 0.001). A mutation in exon 10 was an independent risk factor of recurrence after STP (odds ratio = 2.19; 95% CI: 1.31; 3.69; P = 0.003). The 5 and 10-year recurrent pHPT probabilities were significantly higher in patients after LTSP with a mutation in exon 10 (37% and 79% vs 30% and 61%; P = 0.016).ConclusionsPersistence, recurrence of pHPT, and reoperation rate are significantly lower after STP than LTSP in MEN1 patients. Genotype seems to be associated with the recurrence of pHPT. A mutation in exon 10 is an independent risk factor for recurrence after STP, and LTSP may not be recommended when exon 10 is mutated.Copyright © 2023 Wolters Kluwer Health, Inc. All rights reserved.

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