Surgical management of presternal recurrence in hyperparathyroidism related to chronic kidney disease.
- 1Universidade Federal de São Paulo (UNIFESP), Department of Otorhinolaryngology and Head and Neck Surgery, São Paulo, SP, Brazil. Electronic address: [email protected].
- 2Universidade Federal de São Paulo (UNIFESP), Department of Otorhinolaryngology and Head and Neck Surgery, São Paulo, SP, Brazil.
- 3Universidade Federal de São Paulo (UNIFESP), Department of Mineral and Bone Disorders, Discipline of Nephrology, São Paulo, SP, Brazil.
Abstract
Objective
To evaluate the surgical management and outcomes of recurrence localized in presternal autografts after total parathyroidectomy with autograft for hyperparathyroidism related to chronic kidney disease.Methods
A retrospective cohort study was conducted including patients submitted to total parathyroidectomy with presternal autograft between 2000 and 2024 who developed biochemical recurrence according to Brazilian Society of Nephrology criteria and required reoperation. Only cases occurring more than six months after an initially effective surgery were included. The primary outcome was sustained biochemical resolution.Results
Twenty-four patients required reoperation due to recurrence in the presternal autograft. All were on hemodialysis at initial surgery. Mean CKD duration was 96-months and mean preoperative PTH level was 1445.4 pg/mL. Thirty-one reoperations were performed; most patients (87.5%) required only one procedure. The mean interval between initial surgery and first graft reoperation was 62.6-months. No invasive growth beyond anatomical limits was observed. Mean intraoperative PTH reduction was 80.8%. Considerable variability was observed between intraoperative PTH reduction and subsequent clinical outcomes. Total graft removal was feasible when indicated.Conclusion
Reoperation for recurrence in presternal autografts was feasible in this series and was associated with satisfactory biochemical control, even in patients requiring multiple procedures. The anatomical characteristics of the presternal region allowed controlled resections without evidence of invasive growth beyond the graft bed.Level of evidence: 3
Related
- Decision-making in primary hyperparathyroidism in older patients: surgical or conservative management?
- Surgical, endovascular, and systemic management of renal cell carcinoma with intravascular recurrence
- Surgical Margin and Risk of Local Recurrence in Children and Young Adults With Nonrhabdomyosarcoma Soft Tissue Sarcoma
- Preoperative parathyroid imaging in CKD-related secondary hyperparathyroidism: a systematic review and diagnostic test accuracy network meta-analysis.
- Evaluating long-term recurrence of cholesteatoma following primary surgery: an umbrella review of surgical techniques and patient factors
BibTeX
@article{neves2026surgical,
title = {{Surgical management of presternal recurrence in hyperparathyroidism related to chronic kidney disease.}},
author = {Murilo Catafesta das Neves and Giovanna Luiza Caxeiro and Davi Knoll Ribeiro and Marcello Rosano and Lillian Andrade da Rocha and Aluizio Barbosa Carvalho and Rodrigo Oliveira Santos},
journal = {Brazilian journal of otorhinolaryngology},
year = {2026},
month = oct,
doi = {10.1016/j.bjorl.2026.101925},
url = {https://europepmc.org/article/MED/42874302},
note = {CC BY},
}
RIS
TY - JOUR
TI - Surgical management of presternal recurrence in hyperparathyroidism related to chronic kidney disease.
AU - Murilo Catafesta das Neves
AU - Giovanna Luiza Caxeiro
AU - Davi Knoll Ribeiro
AU - Marcello Rosano
AU - Lillian Andrade da Rocha
AU - Aluizio Barbosa Carvalho
AU - Rodrigo Oliveira Santos
PY - 2026
DA - 2026/10/14
JO - Brazilian journal of otorhinolaryngology
DO - 10.1016/j.bjorl.2026.101925
UR - https://europepmc.org/article/MED/42874302
AB - Objective To evaluate the surgical management and outcomes of recurrence localized in presternal autografts after total parathyroidectomy with autograft for hyperparathyroidism related to chronic kidney disease.Methods A retrospective cohort study was conducted including patients submitted to total parathyroidectomy with presternal autograft between 2000 and 2024 who developed biochemical recurrence according to Brazilian Society of Nephrology criteria and required reoperation. Only cases occurring more than six months after an initially effective surgery were included. The primary outcome was sustained biochemical resolution.Results Twenty-four patients required reoperation due to recurrence in the presternal autograft. All were on hemodialysis at initial surgery. Mean CKD duration was 96-months and mean preoperative PTH level was 1445.4 pg/mL. Thirty-one reoperations were performed; most patients (87.5%) required only one procedure. The mean interval between initial surgery and first graft reoperation was 62.6-months. No invasive growth beyond anatomical limits was observed. Mean intraoperative PTH reduction was 80.8%. Considerable variability was observed between intraoperative PTH reduction and subsequent clinical outcomes. Total graft removal was feasible when indicated.Conclusion Reoperation for recurrence in presternal autografts was feasible in this series and was associated with satisfactory biochemical control, even in patients requiring multiple procedures. The anatomical characteristics of the presternal region allowed controlled resections without evidence of invasive growth beyond the graft bed.Level of evidence: 3
SN - 1808-8694
SN - 1808-8686
ER -