Background: The potential long-term survival benefits of surgical resection for synchronous liver-only metastases of pancreatic ductal adenocarcinoma (liver oligo-PDAC) remain controversial. This systematic review and meta-analysis aim to compare the current evidence on long-term survival outcomes between surgical treatment of liver oligo-PDAC and conventional systemic chemotherapy. Materials and methods: A systematic review and meta-analysis were conducted using the PubMed and Scopus databases to identify studies comparing surgery and systemic chemotherapy in terms of long-term survival in oligo-PDAC patients. The search included studies published up to October 2024. The meta-analysis was performed using the Jamovi software. Results: Eleven retrospective studies were selected for a total of 897 patients: 565(63%) underwent synchronous resection of liver metastases and the primary tumor, while 332(37%) received conventional chemotherapy. The majority of patients presented a pancreatic head tumor, and the median number of liver metastases ranged between 1 and 3 in the surgical cohort and 1 and 2 in the nonsurgical cohort. The rate of major surgical complications was 14.4% while the cumulative incidence of postoperative mortality was 2.8%. The median overall survival(OS) in the surgical group ranged from 7.6 to 18.4 months, while a lower value comprised between 6 and 9.9 months was evidenced in the nonsurgical cohort. Six studies were included in the meta-analysis for the OS evaluation, showing significantly better survival outcomes in the surgical group (OR: 0.286, 95% CI: 0.100–0.409; P < 0.0001). According to the Q-test, there was no significant heterogeneity in the true outcomes (Q = 4.063, P = 0.541, I ² = 0 %). A sensitivity analysis, conducted by excluding one study at a time, confirmed the robustness of the meta-analysis findings. Conclusions: Surgical resection of oligo-PDAC may represent a valuable treatment option with potential long-term survival benefits. However, prospective randomized trials are required to further validate these findings.

It is known that a percentage of patients who undergo total thyroidectomy, approximately 16–34%, complain of symptoms of hypothyroidism or altered quality of life (QoL) despite achieving normal serum TSH values. The present study aimed to identify whether the level of selenium could be responsible for this phenomenon. This pilot cohort study included 44 thyroidectomized outpatients. All patients underwent surgery for benign disease. In this study, no patients with a history of autoimmunity, malignancy, or other conditions that could affect well-being, absorption, or selenium intake were included. Serum levels of TSH, fT3, fT4, Selenoprotein P (SelP), and glutathione peroxidase 3 (GPx3) were measured. The patients also completed the ThyPRO-39 questionnaire to assess their QoL. A strong and significant direct correlation was found between SelP and GPx3 (r = 0.88). However, no correlation was found between hormonal status and SelP or GPx3. Analysis of ThyPRO-39 results did not show clinically significant differences between items nor a correlation with thyroid hormone levels, except for symptoms of hypothyroidism. Interestingly, a significant direct correlation was observed between SelP and tiredness, as well as between GPx3 and tiredness. Furthermore, the fT3/fT4 ratio was correlated with worsening symptoms of hypothyroidism. The results suggest that the selenium status, in turn related to antioxidant activities, as reflected in SelP and GPx3 levels, may be associated with the QoL tiredness domain in thyroidectomized patients, despite normal levels of thyroid hormones. More research is needed to elucidate the role of selenium in the persistent symptoms experienced by some thyroidectomized patients.

Synchronous multiple parathyroid carcinoma is a rare condition within the already uncommon landscape of parathyroid malignancies, which comprise less than 1% of sporadic primary hyperparathyroidism cases. To date, only seven cases of synchronous multiple parathyroid carcinoma in sporadic primary hyperparathyroidism have been documented. This exceptional rarity complicates both the diagnostic process and therapeutic decision-making. Clinically, parathyroid carcinoma typically presents as a single mass determining severe symptoms. However, no single clinical, biochemical, or imaging feature allows for definitive preoperative diagnosis. Imaging modalities such as ultrasound and sestamibi scans exhibit variable sensitivity and may overlook multi-gland involvement. Histopathological examination remains the only reliable diagnostic method. Management strategies are also controversial: while some advocate for conservative surgery, en bloc resection is generally recommended for its association with improved local control and disease-free survival. Given the exceptional occurrence of synchronous multiple parathyroid carcinoma, there is a lack of standardized protocols for managing parathyroid carcinoma in cases of synchronous and multiple gland involvement. Early multidisciplinary evaluation and individualized treatment planning are therefore crucial. This review aims to synthesize the presently available knowledge about synchronous multiple parathyroid carcinoma, assist clinicians with the limited data available, and discuss the main challenges in the management of this rare entity.

Synchronous multiple parathyroid carcinoma (SMPC) is a rare condition within the already uncommon landscape of parathyroid malignancies, which comprise less than 1% of sporadic primary hyperparathyroidism (sPHP) cases. To date, only seven cases of SMPC in sPHP have been documented. This exceptional rarity complicates both the diagnostic process and therapeutic decision-making. Clinically, parathyroid carcinoma (PC) typically presents as a single mass determining severe symptoms. However, no single clinical, biochemical, or imaging feature allows for definitive preoperative diagnosis. Imaging modalities such as ultrasound (US) and Sestamibi (MIBI) scan exhibit variable sensitivity and may overlook multi-gland involvement. Histopathological examination remains the only reliable diagnostic method. Management strategies are also controversial: while some advocate for conservative surgery, en bloc resection is generally recommended for its association with improved local control and disease-free survival. Given the exceptional occurrence of SMPC, there is a lack of standardized protocols to manage PC in case of synchronous and multiple gland involvement. Early multidisciplinary evaluation and individualized treatment planning are therefore crucial. This review aims to synthesize currently available knowledge about SMPC to assist clinicians with the limited data available and guide decision-making in the management of this rare and challenging entity.