Total parathyroidectomy versus total parathyroidectomy with autotransplantation for secondary hyperparathyroidism: Systematic review and meta-analysis

Abstract

Background: Total parathyroidectomy (tPTX) and total parathyroidectomy with autotransplantation (tPTX þ AT) are effective and inexpensive treatments for secondary hyperparathyroidism (sHPT), but we do not know which one is the optimal approach. Therefore, we undertook a meta-analysis to compare the safety and efficacy of these two surgical procedures. Methodology: Studies published in English on PubMed, Embase and the Cochrane Library from inception to 27 September 2016 were searched systematically. Eligible studies comparing tPTX with tPTX þ AT for sHPT were included and Review Manager v5.3 was used. Results: Eleven studies were included in this meta-analysis. Ten cohort studies and one randomized controlled trial (RCT) involving 1108 patients with sHPT were identified. There was no significant difference in the prevalence of surgical complications (relative risk [RR], 1.71; 95% confidence interval [CI], 0.77–3.79; p.19), all-cause mortality (RR, 0.68; 95% CI, 0.33–1.39; p.29), sHPT persistence (RR, 3.81; 95% CI, 0.56–25.95; p.17) or symptomatic improvement (RR, 1.02; 95% CI, 0.91–1.13; p.79). tPTX could reduce the risk of sHPT recurrence (RR, 0.19; 95% CI, 0.09–0.41; p