Local resection may be adequate for localized parathyroid carcinoma, according to the results of a National Cancer Database study published in the European Journal of Surgical Oncology.
According to the study authors, parathyroid carcinoma is rare and often is diagnosed incidentally after local resection for other indications. Radical surgery has been considered the treatment of choice if parathyroid carcinoma is suspected.
However, guidelines from the American Association of Endocrine Surgeons for the management of primary hyperparathyroidism indicate that “…if [parathyroid carcinoma] is encountered, en bloc resection should be performed if necessary to avoid capsular disruption, but prophylactic central or lateral neck dissection should be avoided.”
In addition, the study authors pointed out that radical surgery “can cause significant morbidity in the form of recurrent laryngeal nerve palsy and muscular dysfunction of the neck and shoulder.”
This study was designed to compare the outcomes of radical surgery with local resection for localized disease. The study included 555 patients with parathyroid carcinoma who had undergone radical surgery (33 patients) or local resection (522 patients) from 2004 to 2015 from the National Cancer Database.
After multivariable analysis, radical surgery was found to have no significant association with overall survival (OS). Neither did positive nodal status and unknown nodal status. There was no difference in OS between patients who had undergone local resection and those who had undergone radical surgery, with median survival not reached in either group at 10 years (median follow-up, 60.4 months; P =.20). The researchers did find several factors associated with worse survival including age above 75 years, unknown ethnicity, and government insurance.
“We propose that patients who are found to have parathyroid carcinoma after undergoing [local resection] for a presumed benign indication may be safely and closely monitored for recurrence, rather than be committed to the morbidity of [radical surgery],” the researchers wrote. “This affirms current guidelines that recommend against routine ipsilateral thyroidectomy and lymphadenectomy.”
Disclosure: One study author declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of authors’ disclosures.
Leonard-Murali S, Ivanics T, Kwon DS, Han X, Steffes CP, Shah R. Local resection versus radical surgery for parathyroid carcinoma: a National Cancer Database analysis. Eur J Surg Oncol. Published online June 27, 2021. doi:10.1016/j.ejso.2021.06.026