Extent of Surgical Resection and Predictors of Outcomes in MEN1-related Hyperparathyroidism: A Systematic Review and Meta-analysis.

Abstract

Primary hyperparathyroidism (PHPT) is the earliest and most frequent manifestation of multiple endocrine neoplasia type 1 (MEN1). The optimal surgical extent remains controversial due to the tradeoff between recurrence and permanent hypoparathyroidism. To evaluate outcomes of different surgical approaches in MEN1-related PHPT and assess preoperative biochemical predictors through systematic review and meta-analysis. MEDLINE, PubMed, Embase.com, LILACS, and CENTRAL were searched from inception to April 2025, following PRISMA guidelines (PROSPERO: CRD420251027970). We included studies on adult MEN1-related PHPT patients undergoing parathyroidectomy with reported recurrence, hypoparathyroidism, and preoperative biochemical data. Two reviewers independently extracted data and assessed study quality. Random-effects models were used to pool risk ratios (RR) with 95% confidence intervals (CI). Meta-regression evaluated associations with preoperative PTH, calcium, and phosphorus. Thirteen studies (915 patients) were included. Less-than-subtotal parathyroidectomy (<STPT) had higher recurrence than subtotal parathyroidectomy (STPT) (RR = 1.26; 95% CI: 1.16-1.36) and total parathyroidectomy with autotransplantation (PTX) (RR = 1.35; 95% CI: 1.22-1.49). STPT showed slightly higher recurrence than PTX (RR = 1.12; 95% CI: 1.02-1.24). <STPT had lower hypoparathyroidism than STPT (RR = 0.90; 95% CI: 0.82-0.98) and PTX (RR = 0.76; 95% CI: 0.63-0.90). Grouping < STPT vs STPT/PTX confirmed higher recurrence (RR = 1.23; 95% CI: 1.03-1.46) and lower hypoparathyroidism (RR = 0.86; 95% CI: 0.78-0.96). No significant associations were found for preoperative PTH, calcium, or phosphorus with outcomes. Conservative surgery reduces hypoparathyroidism but increases recurrence. Personalized surgical strategies are essential in MEN1-related PHPT.