Effect of different surgical procedures of parathyroidectomy on secondary hyperparathyroidism: a meta-analysis

Objective To evaluate the effect of total parathyroidectomy and autotransplantation (TPTX+AT) and total parathyroidectomy (TPTX) on secondary hyperparathyroidism (SHPT). Methods PubMed, EMBASE and Cochrane library were searched from inception to June 2017 for relative studies, which were screened according to inclusion criteria. Meta-analysis of included study were conducted to compare the improvement of symptoms, persistent SHPT, recurrent SHPT, reoperation, hypoparathyroidism, duration of operation and hospitalization between TPTX+AT group and TPTX group. Results A total of 11 studies with 1212 patients were included. Results of meta-analyses showed no difference between TPTX+AT and TPTX regarding improvement of symptoms and persistent SHPT (RR=1.03, P=0.70; RR=0.81, P=0.67, respectively), but TPTX was associated with lower risks of recurrent SHPT and reoperation (RR=0.25, P<0.01; RR=0.19, P<0.01). Patients with TPTX had higher rate of hypoparathyroidism (RR=2.68, P<0.01) but shorter time of operation (MD=-17.3, P=0.01). Durations of hospitalization were similar between the two groups (MD=-0.06, P=0.98). Conclusion Compared with TPTX+AT, TPTX reduces the risks of recurrent SHPT, reoperation and operation time, but has higher risk of hypoparathyroidism. Key words: Hyperparathyroidism, secondary; Parathyroidectomy; Meta-analysis