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Oncologic Resection Achieving R0 Margins Improves Disease-Free Survival in Parathyroid Cancer

  • Endocrine Tumors
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

Parathyroid cancer has a poor mid-term prognosis, often because of local recurrence, observed in half of all patients. Modern diagnostic workup increasingly enables a preoperative diagnosis of parathyroid cancer. There is limited evidence that more comprehensive oncologic surgery can reduce the risk of local recurrence. This study aims to identify the best specific surgical approach in parathyroid cancer.

Methods

This observational cohort study comprises 19 consecutive patients who had undergone oncologic or nononcologic resection for parathyroid cancer. Baseline parameters were compared by using univariate analysis; outcomes were assessed by χ 2 testing and Kaplan–Meier statistics.

Results

Fifteen of 19 patients were primarily operated on in our tertiary center between 1996 and 2013, and four were referred for follow-up because of their cancer diagnosis. Patient cohorts defined by histologic R-status were comparable for established risk factors: sex, calcium levels, low-risk/high-risk status, and presence of vascular invasion. Oncologic resections were performed in 13 of 15 patients primarily treated in the center and 0 of 4 treated elsewhere (χ 2 = 5.6; p < 0.01). R0 margins were achieved in 11 of 13 (85 %) undergoing oncologic resection and 1 of 6 (17 %) undergoing local excision (χ 2 = 8.1; p < 0.01). R0 margins and primary oncologic resection were associated with higher disease-free survival rates (χ 2 = 7.9; p = 0.005 and χ 2 = 4.7; p = 0.03, respectively). Revision surgery achieved R0 margins in only 2 of 4 (50 %) of patients.

Conclusions

In parathyroid cancer, a more comprehensive surgery (primary oncologic resection) provides significantly better outcomes than local excision as a result of reduction of R1 margins and locoregional recurrence.

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Disclosure

The authors have nothing to disclose.

Author information

Authors and Affiliations

  1. Department of Endocrine Surgery, King’s College Hospital, King’s Health Partners, King’s College London, London, UK

    K. M. Schulte MD, FRCS, N. Talat BSc (Hons) & G. Galata MD

  2. Department of Endocrinology, King’s College Hospital, King’s Health Partners, London, UK

    J. Gilbert PhD

  3. Department of Histopathology, King’s College Hospital, King’s Health Partners, London, UK

    S. Diaz-Cano MD, PhD, FRCPath

  4. Department of Endocrinology, University Hospital Lewisham, London, UK

    J. Miell FRCPE, FRCP

  5. Diabetes and Bone Diseases, Dresden Technical University Medical Centre, Dresden, Germany

    L. C. Hofbauer MD

  6. Department of Medicine III, Dresden Technical University Medical Centre, Dresden, Germany

    A. Barthel MD & S. R. Bornstein MD, PhD

  7. Department of Diabetes and Endocrinology, King’s College London, London, UK

    S. R. Bornstein MD, PhD

  8. Department of Surgery, John Curtin School of Medical Research, Australian National University, Canberra, Australia

    K. M. Schulte MD, FRCS

Authors
  1. K. M. Schulte MD, FRCS
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  2. N. Talat BSc (Hons)
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  3. G. Galata MD
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  4. J. Gilbert PhD
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  5. J. Miell FRCPE, FRCP
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  6. L. C. Hofbauer MD
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  7. A. Barthel MD
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  8. S. Diaz-Cano MD, PhD, FRCPath
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  9. S. R. Bornstein MD, PhD
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Corresponding author

Correspondence to K. M. Schulte MD, FRCS.

Appendix

Appendix

See Appendix Tables 4, 5 and 6.

Appendix Table 4 Clinical presentation of 19 patients with parathyroid cancer
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Appendix Table 5 Treatment and outcomes based on histology
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Appendix Table 6 Univariate analysis comparing cohorts undergoing nononcologic and oncologic resection
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Schulte, K.M., Talat, N., Galata, G. et al. Oncologic Resection Achieving R0 Margins Improves Disease-Free Survival in Parathyroid Cancer. Ann Surg Oncol 21, 1891–1897 (2014). https://doi.org/10.1245/s10434-014-3530-z

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  • DOI: https://doi.org/10.1245/s10434-014-3530-z

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