Extent of Surgical Resection and Predictors of Outcomes in MEN1-Related Hyperparathyroidism: A Systematic Review and Meta-Analysis

Context Primary hyperparathyroidism (PHPT) is the earliest and most frequent manifestation of multiple endocrine neoplasia type 1 (MEN1). The optimal surgical extent remains controversial due to the trade-off between recurrence and permanent hypoparathyroidism. Objective To evaluate outcomes of different surgical approaches in MEN1-related PHPT and assess preoperative biochemical predictors through systematic review and meta-analysis. Data Sources MEDLINE, PubMed, Embase.com, LILACS, and CENTRAL were searched from inception to April 2025, following PRISMA guidelines (PROSPERO: CRD420251027970). Study Selection We included studies on adult MEN1-related PHPT patients undergoing parathyroidectomy with reported recurrence, hypoparathyroidism, and preoperative biochemical data. Data Extraction Two reviewers independently extracted data and assessed study quality. Random-effects models were used to pool risk ratios (RR) with 95% confidence intervals (CI). Meta-regression evaluated associations with preoperative PTH, calcium, and phosphorus. Data Synthesis Thirteen studies (915 patients) were included. Less-than-subtotal parathyroidectomy (<STPT) had higher recurrence than subtotal (STPT) (RR = 1.26; 95% CI: 1.16–1.36) and total parathyroidectomy with autotransplantation (PTX) (RR = 1.35; 95% CI: 1.22–1.49). STPT showed slightly higher recurrence than PTX (RR = 1.12; 95% CI: 1.02–1.24). <STPT had lower hypoparathyroidism than STPT (RR = 0.90; 95% CI: 0.82–0.98) and PTX (RR = 0.76; 95% CI: 0.63–0.90). Grouping <STPT vs STPT/PTX confirmed higher recurrence (RR = 1.23; 95% CI: 1.03–1.46) and lower hypoparathyroidism (RR = 0.86; 95% CI: 0.78–0.96). No significant associations were found for preoperative PTH, calcium, or phosphorus with outcomes. Conclusions Conservative surgery reduces hypoparathyroidism but increases recurrence. Personalized surgical strategies are essential in MEN1-related PHPT.