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[23, 24].

A report from Japan also found that when comparing the PTx group and non-PTx group in patients with advanced SHPT using propensity score match, the is reduced by 34% and 41%, respectively, compared to the non-PTx group [25]. Similarly, from USRDS data, the PTx group, non-PTx group

A group matching report also showed that PTx improved overall mortality [26]. In addition, it has been reported that PTx improves LVH, improves anemia, , i, [27-31]. Furthermore, PTx is a treatment with good cost-effectiveness. Regarding the safety of PTx, the mortality rate within 30 days after PTx was reported to be 2.0-3.1% [26, 32].

In addition to conventional medical treatments, the emergence of calcimimetics such as cinacalcet, followed by evocalcet, and etelcalcetide has made it necessary to reposition PTx, which had been the mainstream treatment up until then. Although no literature directly compares the effectiveness of calcimimetics and PTx on overall mortality, there is a meta-analysis comparing medical treatment including calcimimetics and PTx. It has been shown that overall mortality rate and cardiovascular mortality rate are improved in the group receiving PTx compared to medical treatment [33, 34]. Furthermore, according to a systematic review that examined the improvement of QOL with cinacalcet and PTx in patients with SHPT, the 36-item Medical Outcomes Study Short-Form Health Survey (SF-36), PTx was found to be effective in improving physical component score and mental component score. On the other hand, cinacalcet showed no improvement in physical component score or mental component score, indicating that PTx was more effective in improving QOL [35]. Regarding cost-effectiveness, PTx is said to be superior to cinacalcet [36, 37].

Endocrine surgeons must establish surgical techniques, preoperative diagnosis, intraoperative diagnosis, follow-up, etc. for reliable PTx, and pass them on to the next generation.

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