Complications of microwave ablation in patients with persistent/recurrent hyperparathyroidism after surgical or ablative treatment

Abstract

Objective

To evaluate the complications associated with microwave ablation (MWA) in treating persistent/recurrent hyperparathyroidism (HPT) post-surgical or ablative treatments.

Materials and methods

From January 2015 to December 2022, 87 persistent/recurrent HPT patients (primary HPT [PHPT]: secondary HPT [SHPT] = 13:74) who underwent MWA after surgical or ablative treatment were studied. Grouping was based on ablation order (initial vs. re-MWA), prior treatment (parathyroidectomy [PTX] vs. MWA), and etiology (PHPT vs. SHPT). The study focused on documenting and comparing treatment complications and analyzing major complication risk factors.

Result

Among the 87 patients, the overall complication rate was 17.6% (15/87), with major complications at 13.8% (12/87) and minor complications at 3.4% (3/87). Major complications included recurrent laryngeal nerve (RLN) palsy (12.6%) and Horner syndrome (1.1%), while minor complications were limited to hematoma (3.4%). Severe hypocalcemia noted in 21.6% of SHPT patients. No significant differences in major complication rates were observed between initial and re-MWA groups (10.7% vs. 13.8%, p = 0.455), PTX and MWA groups (12.5% vs. 15.4%, p = 0.770), or PHPT and SHPT groups (15.4% vs. 13.5%, p > 0.999). Risk factors for RLN palsy included ablation of superior and large parathyroid glands (>1.7 cm). All patients recovered spontaneously except for one with permanent RLN palsy in the PTX group (2.1%).

Conclusion

Complication rates for MWA post-surgical or ablative treatments were comparable to initial MWA rates. Most complications were transient, indicating MWA as a viable and safe treatment option for persistent/recurrent HPT patients.

Keywords:

• Microwave ablation
• complication
• hyperparathyroidism
• recurrent laryngeal nerve

Disclosure statement

No potential conflict of interest was reported by the author(s).

Data availability statement

Some or all datasets generated during and/or analyzed during the current study are not publicly available but are available from the corresponding author on reasonable request.

Additional information

Funding

This work was funded by National High Level Hospital Clinical Research Funding, Elite Medical Professionals Project of China-Japan Friendship Hospital [NO. ZRJY2023-GG19], National High Level Hospital Clinical Research Funding [grant 2023-NHLHCRF-YYPP-TS-01], National High-Level Hospital Clinical Research Funding [2022-NHLHCRF-PY-07], Beijing Research Ward Project [2022-YJXBF-04-04], and The National Natural Science Foundation of China [62176268].