Abstract：
BACKGROUND: Medullary thyroid carcinoma (MTC) is a rare neuroendocrine tumor from parafollicular cells that produce calcitonin (Ct). Despite several existing guidelines for the surgical management of sporadic MTC (sMTC), optimal initial surgical management of the thyroid, the central and the lateral neck remains a matter of debate.
METHODS: A systematic review in PubMed and Scopus for current guidelines addressing the surgical management of sMTC and its referenced citations was conducted as per the PRISMA guidelines.
RESULTS: Two-hundred and one articles were identified, of which 7 met the inclusion criteria. Overall, guidelines vary significantly in their recommendations for the surgical management of sMTC. Only one guideline recommended partial thyroidectomy for limited disease, but the possibility to avoid completion thyroidectomy in selected cases is acknowledged in 42% (3/7) of the remaining guidelines. The majority of guidelines (71.4%; 5/7) recommended prophylactic central neck dissection (CND) for all patients while the remaining two guidelines recommended CND based on Ct level and tumor size. The role of prophylactic lateral neck dissection based on preoperative Ct levels was recommended by 42% (3/7) of guidelines. Overall, these guidelines are based on low-quality evidence, mostly single-center retrospective series, some of which are over 20 years old.
CONCLUSIONS: Current surgical management guidelines of sMTC should be revised, and ought to be based on updated data challenging current recommendations, which are based on historic, low-quality evidence. Partial thyroidectomy may become a viable option for small, limited tumors. Prospective, multi-center studies may be useful to conclude whether prophylactic ND is necessary in all sMTC patients.
METHODS: A systematic review in PubMed and Scopus for current guidelines addressing the surgical management of sMTC and its referenced citations was conducted as per the PRISMA guidelines.
RESULTS: Two-hundred and one articles were identified, of which 7 met the inclusion criteria. Overall, guidelines vary significantly in their recommendations for the surgical management of sMTC. Only one guideline recommended partial thyroidectomy for limited disease, but the possibility to avoid completion thyroidectomy in selected cases is acknowledged in 42% (3/7) of the remaining guidelines. The majority of guidelines (71.4%; 5/7) recommended prophylactic central neck dissection (CND) for all patients while the remaining two guidelines recommended CND based on Ct level and tumor size. The role of prophylactic lateral neck dissection based on preoperative Ct levels was recommended by 42% (3/7) of guidelines. Overall, these guidelines are based on low-quality evidence, mostly single-center retrospective series, some of which are over 20 years old.
CONCLUSIONS: Current surgical management guidelines of sMTC should be revised, and ought to be based on updated data challenging current recommendations, which are based on historic, low-quality evidence. Partial thyroidectomy may become a viable option for small, limited tumors. Prospective, multi-center studies may be useful to conclude whether prophylactic ND is necessary in all sMTC patients.
摘要：
背景：甲状腺髓样癌（MTC）是一种罕见的神经内分泌肿瘤，来自产生降钙素（Ct）的滤泡旁细胞。尽管目前有一些零星MTC（sMTC）的手术治疗指南，甲状腺的最佳初始手术管理，中央和外侧颈部仍然是一个争论的问题。
方法：在PubMed和Scopus中，根据PRISMA指南对目前的sMTC手术治疗指南及其引用进行了系统评价。
结果：确定了200篇文章，其中7人符合纳入标准。总的来说,指南对sMTC手术治疗的建议差异很大.只有一个指南建议甲状腺部分切除术治疗有限的疾病，但其余指南的42%(3/7)承认在选定病例中避免完成甲状腺切除术的可能性.大多数指南（71.4％；5/7）建议对所有患者进行预防性中央颈清扫术（CND），而其余两个指南建议基于Ct水平和肿瘤大小进行CND。42％（3/7）的指南推荐了基于术前Ct水平的预防性侧颈清扫术的作用。总的来说,这些指南是基于低质量的证据，主要是单中心回顾系列，其中一些已经超过20岁了。
结论：应修订现行的sMTC手术管理指南，并且应该基于挑战当前建议的最新数据，基于历史，低质量的证据。甲状腺部分切除术可能成为小型手术的可行选择，有限的肿瘤。前瞻性,多中心研究可能有助于得出所有sMTC患者是否需要预防性ND的结论.
方法：在PubMed和Scopus中，根据PRISMA指南对目前的sMTC手术治疗指南及其引用进行了系统评价。
结果：确定了200篇文章，其中7人符合纳入标准。总的来说,指南对sMTC手术治疗的建议差异很大.只有一个指南建议甲状腺部分切除术治疗有限的疾病，但其余指南的42%(3/7)承认在选定病例中避免完成甲状腺切除术的可能性.大多数指南（71.4％；5/7）建议对所有患者进行预防性中央颈清扫术（CND），而其余两个指南建议基于Ct水平和肿瘤大小进行CND。42％（3/7）的指南推荐了基于术前Ct水平的预防性侧颈清扫术的作用。总的来说,这些指南是基于低质量的证据，主要是单中心回顾系列，其中一些已经超过20岁了。
结论：应修订现行的sMTC手术管理指南，并且应该基于挑战当前建议的最新数据，基于历史，低质量的证据。甲状腺部分切除术可能成为小型手术的可行选择，有限的肿瘤。前瞻性,多中心研究可能有助于得出所有sMTC患者是否需要预防性ND的结论.
