Comparison Between Subtotal Parathyroidectomy and Total Parathyroidectomy with Autotransplantation for Secondary Hyperparathyroidism in Patients with Chronic Renal Failure: A Meta-Analysis

摘要

We conducted a meta-analysis of randomized and 2-arm prospective or retrospective studies that compared the efficacy of PTX and TPTX+AT in patients with medically uncontrollable secondary HPT due to chronic renal failure. Citations were identified in the Medline, Cochrane, EMBASE, and Google Scholar databases through April 2014. The primary outcome of interest was HPT recurrence rate, while secondary outcomes included changes in serum calcium (Ca++), parathyroid hormone (PTH), alkaline phosphatase (ALP), and phosphate (P) levels. Five studies were included in the present analysis. The NOS score of all the included studies was 7 or above, and heterogeneity among the studies was minimal for 3 of the 5 outcomes. The HPT recurrence rate was similar for patients who underwent SPTX vs. TPTX+AT [odds ratio (OR)=0.825; 95% confidence interval (CI)=0.368 to 1.846; p=0.639]. The changes in serum Ca++, PTH, ALP, and P were also similar between the 2 treatment groups (Ca++: Std diff in means=-0.166; 95% CI=-0.703 to 0.371; p=0.545; PTH: pooled diff in means=561.17; 95% CI=-174.30 to 1296.6; p=0.135; ALP: pooled diff in means=0.58; 95% CI=-70.07 to 71.24; p=0.987; P: pooled Std diff in means=0.26; 95% CI=-0.091 to 0.630; p=0.143). Our findings indicate that SPTX and TPTX+AT are equally successful in preventing recurrent HPT and improving secondary HPT. We therefore, conclude that the choice of procedure can be left to the surgeons.