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Background and aims: Intra-operative parathyroid hormone (IOPTH) results are not known in the setting of tertiary hyperparathyroidism (HPT) after renal transplantation. Materials and methods: A retrospective analysis of 35 tertiary HPT patients who all underwent subtotal parathyroidectomy and IOPTH monitoring was conducted. Results: The mean follow-up time was 2.2±1.4years. Thirty-four patients were cured; one patient (2.8%) had a persistent disease and was cured after reoperation. Median parathyroid hormone (PTH) (median percent decrease from highest) at baseline and at 5, 10, 20, and 30min were 244, 78 (69%), 63 (75%), 53 (79%), and 49pg/ml (83%), respectively. Four patients who were cured had a decrease of <50% at 5min and two of them had a decrease of <50% at 10min. The patient with persistent disease had a decrease of >50% at 10min. The sensitivity of the test was 94% at 10min using the Miami criteria. Conclusion: This study shows that IOPTH in tertiary hyperparathyroidism has a high sensitivity. However, because of the low risk of persistent hyperparathyroidism when a subtotal parathyroidectomy is performed, its potential impact on the overall success rate is very small. We therefore do not recommend the routine use of IOPTH in tertiary hyperparathyroidism

Background: The management of small, nonfunctioning pancreaticoduodenal endocrine tumors (NFPET) in multiple endocrine neoplasia type 1 (MEN1) patients is still controversial. We therefore investigated the effect of surgery on survival and tumor progression in MEN1 patients with NFPET ≤2 cm by analyzing data from the Groupe des Tumeurs Endocrines (GTE) registry. Materials and Methods: Among 579 MEN1 patients in the registry, 65 had NFPET ≤ 2 cm. Fifteen (23%) underwent pancreatectomy, 9 at least segmental pancreatectomies and 6 biopsies or enucleations (the surgery group), and 50 (77%) were followed conservatively (the no surgery group). Age at MEN1 and NFPET diagnosis was similar in both groups, as was size of the primary tumor. Seven (10.8%) patients had metastases. Five metastases were synchronous, and 2 (one in each group) were metachronous. Tumor size was similar in patients with or without metastasis. Results: There was no perioperative mortality. The average follow-up time after NFPET diagnosis was 6.7 years in the surgery group and 3.3 years in the no surgery group. Three (4.6%) patients died during follow-up, 2 due to NFPET and 1 due to thymus tumor. The 2 patients who died of NFPET had undergone pancreatic surgery at the time of NFPET diagnosis. The 2 groups did not differ significantly with respect to tumor progression [5/15 (33%) vs 6/38 (16%), P = 0.16]. Overall life expectancy of patients with NFPET ≤2 cm was not different than that of the 229 MEN1 patients in the registry without any pancreaticoduodenal tumor (P = 0.33). Conclusions: This study suggests that surgery may not be beneficial for MEN1 patients with NFPET ≤2 cm

In a multiinstitutional review, data on 396 patients with benign solitary or multiple insulinomas operated on in 15 centers were collected. In these 396 patients, 419 laparotomies (375 primary procedures and 44 reoperations) were performed. The rate of unnecessary laparotomies was 1.7%. Complications occurred after 132 operations (31.5%), requiring 27 reinterventions (6.4%). Ten (2%) patients died within 30 days of surgery. The success rate of first procedures in the centers was 94.9%. After reoperation, all but 2 (99.5%) of these patients were cured. The overall cure rate including those patients who had their primary operations elsewhere was 97.5% . Compilant les dossiers de 15??tablissements internationaux, nous avons collig?? les donn??es concernant 396 patients pr??sentant un insulinome b??nin unique ou multiple, op??r??s. Chez ces 396 patients, 419 laparotomies (375 interventions de premi??re intention et 44 reprises) ont??t?? effectu??es. Le taux de laparotomie inutile??tait de 1.7%. Des complications sont intervenues?? la suite de 132 op??rations (31.5%), n??cessitant 27 r??interventions (6.4%). Dix (2%) patients sont morts dans les trente jours apr??s l'acte chirurgical. Le taux de succ??s des interventions de premi??re intention dans les centres de l'??tude??tait de 94.9%. Apr??s r??interventions, tous les patients sauf 2 (99.5%) ont??t?? gu??ris. Le taux global de gu??rison, y compris les patients ayant??t?? op??r??s une premi??re fois ailleurs,??tait de 97.5%. En una revisi??n multiinstitucional se recolectaron los datos sobre 396 pacientes con insulinomas benignos solitarios o m??ltiples operados en 15 centros. En estos 396 pacientes se efectuaron 419 laparotom??as (375 procedimientos primarios y 44 reoperaciones). Se registr?? una tasa de laparotom??as innecesarias de 1.7%; se presentaron complicaciones despu??s de 132 operaciones (31.5%), las cuales requirieron 27 reintervenciones (6.4%). Diez (2%) pacientes murieron dentro de los primeras 30

What is the future of thyroid surgery in the new millennium? How can surgeons keep abreast of advances in thyroid endocrinology, genetics surgical therapy, and other aspects of thyroid disease management? How should surgeons be trained to become highly competent in thyroid disease and to perform safe, effective thyroid operative procedures? Nine internationally recognized endocrine surgeons were asked to express their views on these and related subjects. They noted that advances in molecular biology, pathology, and genetics of thyroid disease should allow more tailored surgical approaches during the twenty-first century. Current training of general surgical residents in thyroid and other types of endocrine surgery is highly variable, which may contribute to increased complication rates and number of second operations. The leadership for addressing these deficiencies and promoting a more organized approach to thyroid disease management should come from national endocrine surgery associations and their leaders. It is incumbent upon endocrine surgeons to maintain their central role in the management of many aspects of thyroid disease. Organizing teams of specialists into thyroid centers (centers of excellence) can (1) increase efficiency, (2) increase quality of care, (3) decrease costs, (4) encourage a more individualized approach to surgery, (5) lower complication rates, and (6) foster innovation in technology and disease management. Two years of additional fellowship training in thyroid and endocrine surgery is now being advocated by increasing numbers of national endocrine surgical associations as the best way to prepare surgeons for society's needs for highly skilled, competent thyroid surgeons of the future.