Abstract Background This study evaluates the feasibility and safety of hemithyroidectomy with ipsilateral central compartment lymph node (ICCLN) dissection in a highly-selected group of sporadic medullary thyroid carcinoma (sMTC) patients. Methods From July 2023, we prospectively evaluated patients with apparently unifocal, cN0 sMTC, to be enrolled in the study. The sporadic nature of MTC was confirmed preoperatively by the absence of RET germline mutations. All patients underwent neck ultrasonography by an experienced operator to confirm the absence of lymph node metastases and extrathyroidal spread. Results Of 15 enrolled patients, 14 (93.3%) had MTC at histology, while 1 (6.7%) patient had C-cell hyperplasia. The mean age was 49.1 ± 9.8 years, with a female predominance (66.7%). Preoperative median basal calcitonin was 68 pg/mL (IQR: 26–367) (Table 1). Median tumour size was 12 mm (IQR: 8–18). Only one (7.1%) patient had multifocal MTC. Desmoplasia ≥20% was observed in 5 (35.7%) patients; however, all MTCs were low-grade. The median number of ICCLN removed was 6 (IQR: 4–9). Lymph-node metastases were identified in 4 (28.6%) patients. All metastatic lymph nodes measured ≤3 mm (Table 2). After a median follow-up of 6 months (IQR: 5–15), no structural recurrences were detected (Table 3). Conclusion In appropriately selected sMTC patients, conservative surgery appears feasible and safe, with a low burden of multifocality and lymph-node metastasis. Strict preoperative selection — aimed at reliably identifying truly sporadic, unifocal, intrathyroidal tumours — is essential to ensure optimal results and maximize the likelihood of cure.
Rossi et al. (Fri,) studied this question.