The results of surgery for mediastinal parathyroid tumors: a comparative study of 63 patients

Background: Parathyroidectomy for mediastinal hyperfunctioning parathyroid glands could be performed by sternotomy, thoracotomy,transcervical approach and recently by thoracoscopic and mediastinoscopic approaches. The aim was to analyze the Results of traditional and videoassisted parathyroidectomy for mediastinal glands. Methods: Sixty-three patients with primary hyperparathyroidism underwent surgery for mediastinal single adenoma, 45 patients underwent upper mediastinal exploration by a transcervical cervicotomy, 6 by sternothomy and 12 by videoassisted parathyroidectomy (2 thoracoscopy and 8 transcervical mediastinoscopy). Results: Sternotomic and videoassisted parathyroidectomy achieved biochemical cure in all cases; persistent hyperparathyroidism occurred in 6 patients following traditional transcervical mediastinal exploration (p<0,01), and were subsequently cured by sternotomy. No complications occurred after endoscopic parathyroidectomy, while an overall morbidity rate of 50% and 10% was found after sternotomy and cervicotomy (p<0,01). Mean analgesic requirement following sternotomy was 4 times higher than cervicotomy and endoscopy (p<0,01). Cosmetic satisfaction score was higher after endoscopy (p<0,01). Conclusions: Sternotomic approaches are effective, although more invasive and with increased morbidity. Satisfactory Results could be achieved by transcervical mediastinal exploration. In case of deeply located tumors, endoscopic approaches represent a lessinvasive, effective, and safe procedure and might be the technique of choice.