ESA-RANDOMIZED CONTROLLED TRIAL Total Parathyroidectomy With Routine Thymectomy and Autotransplantation Versus Total Parathyroidectomy Alone for Secondary Hyperparathyroidism

Objective: This randomized controlled multicenter pilot trial was conducted to find robust estimates for the rates of recurrence of 2 surgical strategies for secondary hyperparathyroidism (SHPT) within 36 months of follow-up. Background: SHPT is a frequent consequence of chronic renal failure. Total parathyroidectomy with autotransplantation (TPTXþAT) and subtotal parathyroidectomy (SPTX) are the standard surgical procedures. Total parathyroidectomy alone (TPTX) might be a good alternative, as morbidity and recurrence rates are low according to small-scale retrospective studies. Methods: The trial was performed as a nonconfirmatory randomized controlled pilot trial with 100 patients on long-term dialysis with otherwise uncontrollable SHPT to generate data on the rate of recurrent disease within a 3-year follow-up period after TPTX or TPTXþAT. Parathyroid hormone (PTH) and calcium levels, recurrent or persistent hyperparathyroidism, parathyroid reoperations, morbidity, and mortality were evaluated during a 3-year follow-up. Results: A total of 52 patients underwent TPTX and 48 TPTXþAT. Patient characteristics, preoperative baseline data, duration of surgery (02:29 vs 02:47 hrs, P 1⁄4 0.17) and mean hospital stay (10 7.1 vs 8 3.7 days, P 1⁄4 0.11) did not differ significantly. Persistent SHPT developed in 1 TPTX and 2 TPTXþAT patients. None of the TPTX patients required delayed parathyroid AT to treat permanent hypoparathyroidism. Serum-calcium values were similar (2.1 0.3 vs 2.1 0.2, P 1⁄4 0.95) whereas PTH rose by time in the TPTXþAT group and was significantly higher at the end of follow-up when compared with the TPTX group (31.7 43.6 vs 98.2 156.8, P 1⁄4 0.02). Recurrent SHPT developed in 4 TPTXþAT and none of the