The Role of Thymectomy During Parathyroidectomy in Multiple Endocrine Neoplasia Type 1-Associated Hyperparathyroidism: A Systematic Review and Meta-Analysis

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Direct databases from inception through February 8, 2024, using terms related to "multiple endocrine neoplasia", "parathyroidectomy", "thymectomy", and other relevant keywords.Reference lists of included studies were hand-searched for additional citations.No language restrictions were applied. Main outcome(s)Concomitant TCT may improve the safety and efficacy of PTX in MEN1-associated PHPT by synergistically clearing all cervical disease and minimizing adverse sequelae.Our findings provide further evidence to support existing recommendations for TCT and can guide surgical decision-making. Quality assessment / Risk of bias analysisThe Newcastle-Ottawa scale was used to appraise the quality of included studies.This scale evaluates studies based on three criteria: selection of study g r o u p s , c o m p a r a b i l i t y o f c o h o r t s , a n d ascertainment of outcomes, using a star rating system. Strategy of data synthesisTwo groups comprised of some of the authors (A.A/M.A.A. and T.B/R.M.E/J.A.J.) independently reviewed titles, abstracts and full texts applying the eligibility criteria.Discrepancies were resolved by consensus after discussion by a senior author (E.T).The following data was extracted into standardized tables: first author, year, country, study design, sample sizes, patient characteristics, surgical details, and rates of outcomes in each group including cure, persistent disease, recurrent disease, reoperation, transient and permanent hypoparathyroidism.Cure was defined as normal s e r u m c a l c i u m o r P T H l e v e l s w i t h o u t supplementation.Persistent disease was defined as elevated serum calcium or PTH levels within six months of surgery.Recurrent disease was defined as elevated serum calcium or PTH levels after six months of surgery.Subgroup analysis A subgroup analysis stratified by geographical location found largely comparable outcomes between European (4 studies) and North American (2 studies) cohorts, without statistically significant evidence of regional differences across endpoints. Sensitivity analysis NA.Country(ies) involved USA/Egypt.

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