Background: Parathyroid cancer (PC) is a rare sporadic or hereditary malignancy whose histologic features were redefined with the 2022 WHO classification. A total of 24 Italian institutions designed this multicenter study to specify PC incidence, describe its clinical, functional, and imaging characteristics and improve its differentiation from the atypical parathyroid tumour (APT). Methods: All relevant information was collected about PC and APT patients treated between 2009 and 2021. Results: Among 8361 parathyroidectomies, 351 patients (mean age 59.0 ± 14.5; F = 210, 59.8%) were divided into the APT (n = 226, 2.8%) and PC group (n = 125, 1.5%). PC showed significantly higher rates (p < 0.05) of bone involvement, abdominal, and neurological symptoms than APT (48.8% vs. 35.0%, 17.6% vs. 7.1%, 13.6% vs. 5.3%, respectively). Ultrasound (US) diameter >3 cm (30.9% vs. 19.3%, p = 0.049) was significantly more common in the PC. A significantly higher frequency of local recurrences was observed in the PC (8.0% vs. 2.7%, p = 0.022). Mortality due to consequences of cancer or uncontrolled hyperparathyroidism was 3.3%. Conclusions: Symptomatic hyperparathyroidism, high PTH and albumin-corrected serum calcium values, and a US diameter >3 cm may be considered features differentiating PC from APT. 2022 WHO criteria did not impact the diagnosis.

Intraoperative nerve monitoring (IONM) has been recognized as a useful adjunct into the field of thyroid and parathyroid surgery, aiding in the accurate identification and preservation of the recurrent laryngeal nerve (RLN), consequently reducing the probability of nerve injury and promoting surgical safety. This investigation seeks to amplify the findings of a similar nationwide survey performed in 2014 by offering an updated assessment of IONM practices among Italian surgical institutions, reflecting a decade of advancements and transformations in clinical approaches. A comprehensive nationwide survey was implemented targeting Italian endocrine surgeons to assess the prevalence, utilization patterns, attitudes and perceptions surrounding IONM in the context of thyroid and parathyroid surgical procedures. Structured questionnaires were administered to seventy endocrine surgery centers, and the resulting data were evaluated employing both quantitative and qualitative analysis methods. The survey disclosed that 67.14% of the participants confirmed the routine deployment of IONM across all cervical surgical procedures, particularly in high-risk contexts. Relative to the findings from 2014, a marked rise in the implementation of IONM has been recorded; however, variability persists, especially between continuous and intermittent monitoring strategies. Surgeons recognized improved surgical safety, decreased complication frequencies, and educational advantages as significant key drivers for the incorporation of IONM. Nonetheless, issues, such as false-positive and false-negative results, along with the lack of standardized protocols, remain barriers to its uniform application. During the past ten years, IONM has been thoroughly adopted by Italian endocrine surgeons as a result of its critical contribution to the improvement of surgical outcomes and the provision of educational resources. However, the results highlight the imperative for further standardization of protocols, the advancement of training programs, and the resolution of reimbursement obstacles to ensure equitable and consistent application of IONM across Italian centers, ultimately optimizing patient care.

Background: Differentiated thyroid carcinoma (DTC) has an excellent prognosis; however, advanced disease is associated with a worse prognosis and is relatively common. Surgery followed by RAI treatment remains the mainstream treatment for a large majority of patients with high- and intermediate-risk DTC, but its benefits should be carefully weighed against the potential for harm. The aim of this paper is to critically review the experience in treating advanced DTC at two tertiary referral centers in Italy. Methods: Retrospective analysis of 300 patients who underwent surgery for ADTC over 30 years. Results: The complication rate was 50.33%. A total of 135 patients (45%) remained at regular follow-up, 118 (87.4%) were alive, while 17 (12.6%) were deceased. The mean overall survival at 12 years was 84.8% with a mean of 238 months. Eleven patients (8.1%) experienced a relapse after a median of 13 months. Conclusions: ADTC patients adequately treated can achieve prolonged survival even in the case of metastasis or disease relapse. Patients with ADTC should be referred to high-volume centers with the availability of an extended multidisciplinary team to receive tailored treatment.

In recent years, total laparoscopic pancreaticoduodenectomy (TLPD) has been introduced as a feasible alternative to open pancreaticoduodenectomy (OPD) when performed by experienced surgeons in laparoscopic and pancreatic surgery. Its application has been gradually increased, but its safety, reproducibility, and oncological outcomes are still debated due to its technical complexity and prolonged operating time. We performed a systematic analysis of the more relevant aspects of TLPD. In this chapter, we report a general overview of the different experiences present in the literature regarding indications, surgical techniques, postoperative outcomes, benefits and limitations of this approach, oncological results, learning curve, and costs. There is no standardized surgical technique for TLPD. Different techniques exist for both the demolitive stage and the reconstructive stage. We summarized the different aspects of the surgical technique based on the various experiences reported by different authors. Compared to OPD, TLPD provides the advantages of laparoscopy, i.e., reduced blood loss, decreased postoperative pain, and shorter length of hospital stay, without increasing the rate of postoperative complications or compromising oncological outcomes. An appropriate patient selection is crucial at the beginning of the learning curve. With increased experience, more challenging cases may also be approached with this technique, including those requiring major vascular resections or multi-visceral resections.