Primer Hiperparatiroidili Hastalarda Paratiroidektomi Sonuçları: Hasta İlişkili Faktörler, Preoperatif Lokalizasyon ve Cerrahi Özelliklerin Etkisi

OBJECTIVE: A better understanding of the factors that may affect surgical success in primary hyperparathyroidism (PHPT) may prevent reoperations, which are known to be associated with more adverse outcomes. This study focuses on identifying the factors influencing surgical success in PHPT, with particular attention to preoperative localization techniques.MATERIAL and METHODS: We included 191 patients who underwent parathyroidectomy (PTx) for PHPT. Demographic, clinical and laboratory data, surgical characteristics, and preoperative localization findings were obtained. Comparisons were made by dividing patients into two groups, successful PTx or failed PTx, according to surgical outcomes. In addition, the correlation between preoperative localization findings and intraoperative findings in the successful PTx group was also evaluated.RESULTS: In our study (with a surgical success rate of 84.29% and a minimally invasive PTx [MIP] rate of 75.39%), parathyroid adenoma (PA) detection on ultrasonography had the highest sensitivity (92.55%) and low serum creatinine (<0.65mg/dL) had the highest specificity (93.33%) in predicting successful PTx. In multivariate analysis, MIP (p<0.001) and low serum creatinine (p=0.008) emerged as independent predictors of successful PTx, whereas diabetes mellitus (p=0.023) was identified as a predictor of failed PTx. We also found that ultrasonography was more concordant with intraoperative findings than was scintigraphy in both exact (65.84% vs. 57.76%) and side-only (80.12% vs. 72.67%) localization.CONCLUSION: Younger age, PA detection on ultrasonography, MIP, and absence of comorbidities (especially diabetes mellitus) may increase the surgical success rate in PHPT. We also think that ultrasonography is superior to scintigraphy for preoperative localization in PHPT. In this context, prospective studies with larger sample sizes are needed.