Localization and reoperation results for persistent and recurrent parathyroid carcinoma

Hypothesis: Reoperation is safe and benefits patients with persistent and r ecurrent parathyroid carcinoma. Design: Retrospective study. The mean follow-up time was 8.1 years (median, 7 years; range, 1-23 years). Setting: A university tertiary referral center. Patients: Eighteen patients treated for parathyroid carcinoma from 1966 to 1999. Results: The mean serum calcium level was 13.7 mg/dL (3.43 mmol/L), and the parathyroid hormone (PTH) level was 1.6 to 20 times the upper limit of nor mal. Fourteen of 18 patients had persistent or recurrent parathyroid carcin oma and underwent 54 reoperations (28 at our institution). Mean time to rec urrence was 4.8 years (range, 1-20 years). Symptoms of hyperparathyroidism were relieved in 86% of patients who had reoperation (P<.05). Reoperation f or parathyroid carcinoma (25 locoregional and 3 distant) significantly redu ced and normalized the serum calcium and PTH levels in 75% and 62% of the c ases, respectively (P<.001). The preoperative serum calcium level was a sig nificant predictor of postreoperative normalization of the serum calcium le vel but not extent of initial resection, PTH level, time to recurrence, con cordance of localization studies, or patient age and sex (P<.01). Surgical complications consisted of 5 unilateral and 1 bilateral permanent recurrent laryngeal nerve palsies (2 intentionally resected en bloc), 1 transient hy poparathyroidism, 1 wound seroma, and 1 tracheoesophageal fistula. The sens itivity rates of sestamibi scan (n=14), magnetic resonance imaging (n=15), computed tumographic scan (n=6), ultrasound (n=13), and selective venous ca theterization with PTH measurement (n=6) were 79%, 93%, 67%, 69%, and 83%, respectively. Conclusions: Recurrence is common in patients with parathyroid carcinoma. P atients with this disease should have frequent, lifelong follow-up to ensur e early detection of recurrence. Although reoperation for persistent or rec urrent parathyroid carcinoma provides significant symptomatic relief and no rmalizes serum calcium and PTH levels in most patients, it is associated wi th some morbidity. Localizing studies of parathyroid carcinoma are helpful but do not detect all tumor foci.