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Late-Breaking Scientific Oral Presentations

Endocrine Surgery

Session: Late Breaking Scientific Orals 1

Management of Medullary Thyroid Carcinoma with Thyroid-Preserving Surgery: Systematic Review and Meta-Analysis

Saturday, October 11, 2025

2:54 PM - 3:00 PM EDT

Location: 245

Introduction: While medullary thyroid carcinoma (MTC) is traditionally treated with total thyroidectomy, recent data suggest that unilateral RET-negative MTC may be safely treated with thyroid lobectomy or subtotal thyroidectomy. We present a systematic review and meta-analysis of postoperative outcomes for MTC treated with thyroid-preserving surgery.

Methods: A systematic review of electronic databases was conducted. Parameters of interest, including RET mutation status, central and lateral lymphadenectomy protocol, biochemical cure, recurrence, mortality, postoperative hypoparathyroidism, and postoperative recurrent laryngeal nerve injury, were extracted, and pooled outcome rates were calculated using a random effects model. Relative risks (RRs) for all outcomes were calculated using a random effects model from studies that included total thyroidectomy comparison cohorts. Interstudy heterogeneity was assessed using the tau-squared (2) statistic.

Results: Ten retrospective studies met inclusion criteria, totaling 309 patients. Thyroid-preserving surgeries resulted in biochemical cure in 73.5% of cases (n = 294, 95% Confidence Interval [CI]: 60.5 - 86.6) and achieved an equivalent risk of biochemical cure compared to total thyroidectomy (RR = 1.3, 95% CI: 1.1 - 1.6, p = 0.01). There was an 8.5% rate of structural recurrence (n = 281, 95% CI: 3.7 - 13.4) and a 3.1% mortality rate (n = 228, 95% CI: 0.0 - 6.9) with thyroid-preserving surgery. Thyroid-preserving surgery achieved a rate of postoperative hypocalcemia of 0.97% (n = 188, 95% CI: 0 - 2.5) and a non-significant RR of 0.28 compared to total thyroidectomy (95% CI: 0.1 - 1.1, p = 0.06).

Conclusions: These aggregate data suggest thyroid-preserving surgery may achieve high rates of oncologic control with low rates of surgical complications for certain patients with RET-negative, unilateral MTC. Further research is needed before thyroid-preserving surgeries can be widely recommended.

Presenting Author(s)

Jacob C. Harris, MD

PGY-2 in Otorhinolaryngology - Head and Neck Surgery
Brooke Army Medical Center
San Antonio, TX, United States

Disclosure(s):
faculty for this accredited education activity has no relationship(s) with ineligible companies to disclose.

Co-Author(s)

OB

Om Balar, BS

University of Pennsylvania, United States

Disclosure information not submitted.
JA

James Aden, PhD

Brooke Army Medical Center, United States

Disclosure information not submitted.
Louis-Xavier Barrette, MD

PGY1
University of Pennsylvania Department of Otorhinolaryngology: Head & Neck Surgery
Philadelphia, PA, United States

Disclosure information not submitted.
DF

D Gregory Farwell, MD

Professor and Chair
University of Pennsylvania School of Medicine
Philadelphia, PA, United States

Disclosure information not submitted.

Senior Author(s)

KR

Karthik Rajasekaran, MD

Associate Professor, Head and Neck Oncologic & Reconstructive Surgeon, Director of QI
Department of Otorhinolaryngology Head and Neck Surgery, Hospital of the University of Pennsylvania
Philadelphia, PA, United States

Disclosure information not submitted.