Recurrence after Surgery for Primary Hyperparathyroidism in 517 Patients with Multiple Endocrine Neoplasia Type 1. An AFCE and GTE study (Association Francophone de Chirurgie Endocrinienne and Groupe d’étude des Tumeurs Endocrines)

Objective: To assess recurrence according to the type of surgery for primary hyperparathyroidism (pHPT) in MEN1 patients and to identify the risk factors for recurrence after initial surgery. Summary Background Data: In MEN 1 patients, pHPT is multiglandular and the optimal extent of initial parathyroid resection influences the risk of recurrence. Methods: MEN1 patients who underwent initial surgery for pHPT between 1990 and 2019 were included. Persistence and recurrence rates after less than subtotal (LTSP) and subtotal (STP) were analyzed. Patients with total parathyroidectomy (TP) with reimplantation were excluded. Results: 517 patients underwent their first surgery for pHPT: 178 had LTSP (34.4%) and 339 STP (65.6%). The recurrence rate was significantly higher following LTSP (68.5%) than STP (45%) ( P <0.001). The median time to recurrence after pHPT surgery was significantly shorter after LTSP than after STP: 4.25 (1.2-7.1) versus 7.2 (3.9-10.1) years ( P <0.001). A mutation in exon 10 was an independent risk factor of recurrence after STP (Odds Ratio=2.19; 95% CI [1.31; 3.69] P =0.003). The five and ten-year recurrent pHPT probabilities were significantly higher in patients after LTSP with mutation in exon 10 (37% and 79% versus 30% and 61% P =0.016). Conclusion: Persistence, recurrence of pHPT and reoperation rate are significantly lower after STP than LTSP in MEN 1 patients. Genotype seems to be associated with recurrence of pHPT. A mutation in exon 10 is an independent risk factor for recurrence after STP and LTSP may not be recommended when exon 10 is mutated.