A short-term non-randomized controlled study of ultrasound-guided microwave ablation and parathyroidectomy for secondary hyperparathyroidism

Abstract

Background

To compare the short-term clinical outcomes of ultrasound-guided microwave ablation (MWA) and parathyroidectomy (PTX) for severe secondary hyperparathyroidism(SHPT).

Methods

In a prospective multi-center study, we compared the outcomes of MWA and PTX for severe SHPT. The outcome measures were case rate of successful treatment, improvement of clinical symptoms, incidence of complications, and differences in treatment parameters and costs between the two groups.

Results

A total of 167 eligible patients were included in the study, of which 79 underwent MWA and 88 underwent PTX. There was no significant difference in rate of successful treatment between the MWA and PTX groups (χ²=2.299, p = 0.125). However, the MWA group showed significantly lower range of intact parathyroid hormone (iPTH) decrease than the PTX group (t=−2.352, p = 0.023). Postoperative clinical symptoms improved in both groups, with no significant difference between the two groups (p > 0.05). Postoperative hypocalcemia was significantly more common in the PTX group (p < 0.05). The operative time, incision and postoperative pain of the MWA group were significantly better than those of the PTX group (p < 0.05), while postoperative recurrent laryngeal nerve injury and hematoma showed no significant difference between the two groups (p > 0.05). The cost of MWA was significantly less than PTX (p = 0.000).

Conclusions

Both MWA and PTX are effective and safe for severe secondary hyperparathyroidism. PTX is more thorough and traumatic, while MWA is minimally invasive and postoperative iPTH is more consistent with the Kidney Disease: Improving Global Outcomes (KDIGO) recommendation.

Keywords:

• Non-randomized controlled study
• ultrasound-guided
• microwave ablation
• parathyroidectomy
• secondary hyperparathyroidism

Acknowledgments

Thanks are due to Junfeng Zhao, Linxue Qian, Changsheng Teng, Mingan Yu, Fangyi Liu, Yujiang Liu, Xiaoqu Tan, Jianming Li for assistance with the study and valuable discussion.

Author contributions

Junfeng Zhao,Linxue Qian did the traditional ultrasound, contrast enhanced ultrasonography examinations and the ablation for the patient in Beijing Friendship Hospital and Junfeng Zhao contributed to manuscript drafting; Yujiang Liu, Xiaoqu Tan assisted ablation operation completed; Mingan Yu was in China-Japan Friendship Hospital, and Fangyi Liu was in the General Hospital of the Chinese People's Liberation Army to complete the ablation of secondary hyperparathyroidism; Changsheng Teng undertaked the surgical resection of secondary hyperparathyroidism; Linxue Qian and Jianming Li were responsible for the revision of the manuscript; all authors issued final approval for the version to be submitted.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Data availability statement

The data set supporting the results of this article are included within the article.

The datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request.

Additional information

Funding

This study was funded by Capital's Funds for Health Improvement and Research in 2018 (2018-1-1112).