Comparison of efficacy and safety between minimally invasive parathyroidectomy and bilateral neck exploration for primary hyperparathyroidism: A systematic review and meta-analysis.

Abstract

Minimally invasive parathyroidectomy has increasingly replaced bilateral neck exploration for primary hyperparathyroidism, yet the comparative efficacy and safety of these 2 surgical approaches remain debated. This meta-analysis aimed to systematically evaluate and compare the efficacy and safety of minimally invasive parathyroidectomy versus bilateral neck exploration for the treatment of primary hyperparathyroidism. Following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, we systematically searched PubMed, Embase, and Cochrane Library for relevant studies. Meta-analysis was performed using RevMan 5.4 and Stata MP 18 to calculate pooled odds ratios and mean differences with 95% confidence intervals. Forty-two studies comprising 12,832 patients were included. No significant difference in cure rate was observed between minimally invasive parathyroidectomy and bilateral neck exploration (odds ratio, 1.20; P = .35). The conversion rate from minimally invasive parathyroidectomy to bilateral neck exploration was 8.5%. Minimally invasive parathyroidectomy was associated with shorter operative time (mean difference, -33.10 min; P = .0002), shorter hospital stays (mean difference, -0.67 days; P < .0001), and lower medical expenses (mean difference, -$2,053.86; P = .0007) compared with bilateral neck exploration. In addition, minimally invasive parathyroidectomy had lower incidences of temporary hypocalcemia (odds ratio, 0.47; P < .00001), hematoma (odds ratio, 0.44; P = .02), recurrent laryngeal nerve injury (odds ratio, 0.53; P = .04), and total adverse events (odds ratio, 0.49; P < .00001). Minimally invasive parathyroidectomy offers comparable cure rates to bilateral neck exploration for primary hyperparathyroidism while providing advantages in reducing operative time, hospital stay, and medical expenses. In addition, minimally invasive parathyroidectomy was associated with lower incidences of temporary hypocalcemia, hematoma, recurrent laryngeal nerve injury, and total adverse events. Minimally invasive parathyroidectomy had an 8.5% conversion rate from minimally invasive parathyroidectomy to bilateral neck exploration. The selection of surgical approach should be individualized based on preoperative localization results, patient conditions, the use of intraoperative parathyroid hormone, and the surgeon's experience. These findings support minimally invasive parathyroidectomy as a safe and effective surgical approach for patients with primary hyperparathyroidism.