在美国甲状腺学会2015年指南更新后，关于临床无淋巴结转移的≤4 cm乳头状甲状腺癌患者进行全甲状腺切除术与局部切除术以及预防性中央颈部淋巴结清扫术之间的持续争论依然存在。本研究旨在评估这一低风险人群手术范围的当代趋势。利用国家癌症数据库的回顾性数据，从2012年至2020年间筛选出患有临床无淋巴结转移的≤4 cm乳头状甲状腺癌的成年患者。主要观察指标是手术范围（局部切除或全甲状腺切除，是否伴有预防性中央颈部淋巴结清扫术）。进行多变量回归分析，以确定与手术范围差异相关的特征。共纳入83,464名患者，其中79.3%为女性，年龄中位数为51岁。大多数患者接受了全甲状腺切除术（伴或不伴预防性中央颈部淋巴结清扫术，分别为39.1%和37.5%），而接受了局部切除术（伴或不伴预防性中央颈部淋巴结清扫术，分别为7.2%和16.2%）的较少。自2012年以来，局部切除剖宫率从18.3%上升至2020年的29.9%，预防性中央颈部淋巴结清扫术率也在增加（分别为42.9%到52.1%）。男性、亚裔美国人、肿瘤较小的患者以及在社区癌症计划中接受治疗的患者发生全甲状腺切除术的可能性减少。年龄较大、男性、黑人种族、肿瘤较小或在社区癌症计划或中低产能机构接受治疗的患者发生预防性中央颈部淋巴结清扫术的可能性减少。在美国甲状腺学会指南变化后，低风险、临床无淋巴结转移的乳头状甲状腺癌手术方法的比例使用率在近年来发生了变化，包括整体局部切除率的增加以及预防性中央颈部淋巴结清扫术率的增加，根据患者和机构水平的因素存在差异。版权所有 © 2023 Elsevier Inc.。保留所有权利。

The continued debate over total thyroidectomy versus lobectomy and declining favor for prophylactic central neck dissection for patients with clinically node-negative papillary thyroid cancer ≤4 cm is ongoing after the 2015 guideline updates from the American Thyroid Association. This study aimed to evaluate contemporary trends in the extent of surgery in this low-risk cohort.Retrospective data from the National Cancer Database were used to identify adult patients with clinically node-negative papillary thyroid cancer ≤4 cm who underwent resection from 2012 to 2020. The primary outcome was the extent of surgery (lobectomy or total thyroidectomy, with or without prophylactic central neck dissection). Multivariable regression was performed to identify characteristics associated with variation in the extent of surgery.Of 83,464 included patients, 79.3% were female patients with a median age of 51 years. The majority underwent total thyroidectomy either with prophylactic central neck dissection (39.1%) or without (37.5%) versus lobectomy with prophylactic central neck dissection (7.2%) or without (16.2%). Lobectomy rates increased from 18.3% in 2012 to 29.9% in 2020. Prophylactic central neck dissection rates also increased (42.9% to 52.1%). Patients who were male sex, Asian American, had smaller tumors or were treated at community cancer programs had a decreased likelihood of total thyroidectomy. Patients who were older, male sex, Black race, with smaller tumors, or were treated at community cancer programs or mid- or low-volume facilities had decreased likelihood of prophylactic central neck dissection.Proportional use rates of operative approaches for low-risk, clinically node-negative papillary thyroid cancer have changed in recent years after the American Thyroid Association guideline changes, including increasing overall rates of lobectomy as well as prophylactic central neck dissection, with differences noted based on patient- and facility-level factors.Copyright © 2023 Elsevier Inc. All rights reserved.