Latest Progress in Risk-Adapted Surgery for Medullary Thyroid Cancer

Area of Science:

• Endocrinology
• Surgical Oncology
• Genetics

Background:

• Advances in preoperative screening (ultrasound, calcitonin) and intraoperative frozen section increase detection of occult sporadic medullary thyroid cancer (MTC).
• These diagnostic tools enable tailored surgical approaches to minimize morbidity and postoperative thyroxine dependence without compromising cure rates.

Purpose of the Study:

• To provide a comprehensive update on risk-adapted surgical strategies for sporadic and hereditary MTC.
• To evaluate the efficacy of intraoperative frozen section-guided surgery for MTC.

Main Methods:

• Systematic review of English-language international literature.
• Analysis of risk-adapted surgical approaches for sporadic and hereditary MTC.
• Evaluation of intraoperative frozen section utility in guiding surgical extent.

Main Results:

• Hemithyroidectomy is a viable option for desmoplasia-negative sporadic MTC, potentially with ipsilateral central node dissection.
• Limited surgery achieved biochemical cure and excellent outcomes in sporadic MTC patients.
• Hemithyroidectomy reduces the need for postoperative thyroxine, but total thyroidectomy is reserved for bilateral disease or hereditary MTC.

Conclusions:

• Hemithyroidectomy is an adequate and safe therapy for desmoplasia-negative sporadic MTC in experienced hands.
• Total thyroidectomy remains mandatory for hereditary MTC due to the risk of malignant progression in residual C cells.