Comparison of Total Parathyroidectomy With and Without Autotransplantation

NCT ID: NCT02536287

Last Updated: 2015-08-31

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

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Recruitment Status

UNKNOWN

Clinical Phase

PHASE3

Total Enrollment

96 participants

Study Classification

INTERVENTIONAL

Study Start Date

2015-09-30

Study Completion Date

2018-12-31

Brief Summary

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The purpose of this study is to compare short-term and long-term efficacy of total parathyroidectomy with autotransplantation and total parathyroidectomy without autotransplantation for Secondary hyperparathyroidism.

Detailed Description

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Background:Secondary hyperparathyroidism (SHPT) is a common disorder in patients with chronic kidney disease. It is caused by permanent stimulation of the orthotopic and heterotopic parathyroid tissue due to phosphate retention, hypocalcemia, and vitamin D insufficiency. Despite the initiation of new therapeutic agents, several patients will require parathyroidectomy.There are three options for the surgical treatment of SHPT:subtotal PTX (3.5-gland resection,SPTX), total PTX with autotransplantation(TPTX+AT), and total PTX without autotransplantation(TPTX).SPTX and TPTX+AT both leave a fragment of activated,proliferated parathyroid tissue.Since the pathophysiological condition of chronic renal failure and maintenance dialysis continues, the growth stimulus persists and may cause recurrent sHPT.The SPTX procedure has a lesser likelihood of a non-functioning remnant, but recurrent disease always requires a neck reoperation that carries a high likelihood of recurrent laryngeal nerve palsy.Therefore most surgeons believe that TPTX+AT is a better procedure for patients with SHPT.

Because of the potential complication of permanent hypocalcemia and adynamic bone disease,TPTX was not introduced into clinical practice.However,recent retrospective studies demonstrated patients after TPTX did not develop permanent hypoparathyroidism and adynamic bone disease as initially expected.Postoperative hypocalcemia is temporary.TPTX may provide an alternative strategy to the currently performed procedures mainly because of the reported lower recurrence rates.An 8-year follow-up study showed the recurrence rates after TPTX is 7%.Recurrence rates after TPTX+AT is 21.4%,and the site of recurrence is located in approximately 80% at the graft and in 20% in the neck.However, to the present there is no randomized controlled trial to Compare the effects of total parathyroidectomy with autotransplantation and total parathyroidectomy without autotransplantation.The purpose of this study is to evaluate the short-term and long-term efficacy of total parathyroidectomy without autotransplantation comparison to total parathyroidectomy with autotransplantation.

Intervention: One hundred patients with SHPT need undergo parathyroidectomy at the Second Hospital of Anhui medical university were selected and divided into total parathyroidectomy without autotransplantation group and total parathyroidectomy with autotransplantation group, each group contains 50 cases.

Results:

1. Clinical data include: intact parathyroid hormone,serum calcium,serum phosphorus,calcium-phosphorus product,hemoglobin,operation time,morbidity,mortality,clinical symptoms and signs,recurrence and reoperation,quality of life scores.
2. Statistical method: groups t-test, analysis of variance were used.

Conditions

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Secondary Hyperparathyroidism

Keywords

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secondary hyperparathyroidism total parathyroidectomy autotransplantation morbidity recurrence postoperative hypocalcemia

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

Primary Study Purpose

TREATMENT

Blinding Strategy

SINGLE

Participants

Study Groups

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total PTX without autotransplantation

all parathyroid glands were found and removed

Group Type EXPERIMENTAL

total PTX without autotransplantation

Intervention Type PROCEDURE

All parathyroid glands were found and removed and sent for histological confirmation,but without autotransplantation.

total PTX with autotransplantation

all parathyroid glands were found and removed,and then a portion of it is sliced into 1\*1\*1 mm pieces for autotransplantation

Group Type ACTIVE_COMPARATOR

total PTX with autotransplantation

Intervention Type PROCEDURE

All parathyroid glands were found and removed and sent for histological confirmation,and then a portion of the smallest, preferably nonnodular parathyroid gland was chosen for autotransplantation,sliced into pieces measuring 1\*1 \*1 mm,and placed into the subcutaneous of the forearm.

Interventions

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total PTX without autotransplantation

All parathyroid glands were found and removed and sent for histological confirmation,but without autotransplantation.

Intervention Type PROCEDURE

total PTX with autotransplantation

All parathyroid glands were found and removed and sent for histological confirmation,and then a portion of the smallest, preferably nonnodular parathyroid gland was chosen for autotransplantation,sliced into pieces measuring 1\*1 \*1 mm,and placed into the subcutaneous of the forearm.

Intervention Type PROCEDURE

Eligibility Criteria

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Inclusion Criteria

* Both male and female, aged 18 or older;
* Intact parathyroid hormone(iPTH) is more than 9 times the upper limit of the normal range (about 600pg/ml), with hypercalcemia or hyperphosphatemia;
* Refractory to medical therapy;
* Provided written informed consent.

Exclusion Criteria

* Primary or tertiary hyperparathyroidism;
* Familial hyperparathyroidism (MENⅠ, MENⅡ, hereditary HPT);
* Neck surgical exploration history;
* Parathyroid malignant tumor.
Minimum Eligible Age

18 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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The Second Hospital of Anhui Medical University

OTHER

Sponsor Role lead

Responsible Party

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xpgeng

vice-president

Responsibility Role PRINCIPAL_INVESTIGATOR

Principal Investigators

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xiaoping geng, professor

Role: PRINCIPAL_INVESTIGATOR

the vice President of the second affiliated hospitalof Anhui medical university

Locations

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the Second Affiliated Hospital of Anhui Medical University

Hefei, Anhui, China

Site Status

Countries

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China

Central Contacts

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xiaoping geng, professor

Role: CONTACT

Phone: 86+13956010132

Email: [email protected]

jin ma

Role: CONTACT

Phone: 86+15056069536

Email: [email protected]

Facility Contacts

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Geng Xiaoping

Role: primary

jin ma

Role: backup

References

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Puccini M, Carpi A, Cupisti A, Caprioli R, Iacconi P, Barsotti M, Buccianti P, Mechanick J, Nicolini A, Miccoli P. Total parathyroidectomy without autotransplantation for the treatment of secondary hyperparathyroidism associated with chronic kidney disease: clinical and laboratory long-term follow-up. Biomed Pharmacother. 2010 May;64(5):359-62. doi: 10.1016/j.biopha.2009.06.006. Epub 2009 Oct 23.

Reference Type RESULT
PMID: 20435429 (View on PubMed)

Jia X, Wang R, Zhang C, Cui M, Xu D. Long-Term Outcomes of Total Parathyroidectomy With or Without Autoimplantation for Hyperparathyroidism in Chronic Kidney Disease: A Meta-Analysis. Ther Apher Dial. 2015 Oct;19(5):477-85. doi: 10.1111/1744-9987.12310. Epub 2015 May 6.

Reference Type RESULT
PMID: 25950238 (View on PubMed)

Tominaga Y, Matsuoka S, Sato T. Surgical indications and procedures of parathyroidectomy in patients with chronic kidney disease. Ther Apher Dial. 2005 Feb;9(1):44-7. doi: 10.1111/j.1774-9987.2005.00213.x.

Reference Type RESULT
PMID: 15828905 (View on PubMed)

Tominaga Y, Uchida K, Haba T, Katayama A, Sato T, Hibi Y, Numano M, Tanaka Y, Inagaki H, Watanabe I, Hachisuka T, Takagi H. More than 1,000 cases of total parathyroidectomy with forearm autograft for renal hyperparathyroidism. Am J Kidney Dis. 2001 Oct;38(4 Suppl 1):S168-71. doi: 10.1053/ajkd.2001.27432.

Reference Type RESULT
PMID: 11576947 (View on PubMed)

Schneider R, Slater EP, Karakas E, Bartsch DK, Schlosser K. Initial parathyroid surgery in 606 patients with renal hyperparathyroidism. World J Surg. 2012 Feb;36(2):318-26. doi: 10.1007/s00268-011-1392-0.

Reference Type RESULT
PMID: 22202993 (View on PubMed)

Other Identifiers

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ahykdxdefsyy12

Identifier Type: -

Identifier Source: org_study_id