Total parathyroidectomy with autotransplantation versus subtotal parathyroidectomy for renal hyperparathyroidism: A systematic review and meta‐analysis
Most of the practical guidelines recommended PTX to patients with end‐stage renal disease and severe SHPT who failed to respond to pharmacological therapy.6 However, there has been an ongoing discussion on the optimal surgical procedures: SPTX, TPTX or TPTX + AT.8 TPTX removes all identifiable parathyroid tissue, which was considered to be associated with dreaded complications, such as severe hypocalcaemia or adynamic bone disease. SPTX and TPTX + AT leaves enough residual parathyroid tissue to support mineral homeostasis. Compared with SPTX, TPTX + AT, not requiring general anaesthesia and cervical re‐exploration, was reported with relative ease and safety. However, no substantial difference has been reported in the recurrence rates (range 5–80%) between the two procedures. While some authors are convinced that TPTX + AT is the superior form of treatment, others still insist on SPTX.11Heretofore, some epidemiological prospective studies with small sample size have been performed to compare the efficacy between the two different surgical procedures. This meta‐analysis was thus conducted based on the published literatures to evaluate and compare the two surgeries (TPTX + AT vs SPTX) on long‐term outcomes.