简介 2015 年 ATA 指南推荐甲状腺叶切除术 (TL) 作为甲状腺全切除术 (TT) 的替代手术治疗低危分化型甲状腺癌。尽管担心疾病复发和需要再次手术的风险增加，但据报道 TL 的使用有所增加。本研究旨在比较因恶性肿瘤接受初始 TL 或 TT 的患者的再手术率，根据手术量描述中心的趋势，并检查与再手术相关的因素。方法 我们查询了 Vizient 临床数据库，了解指南变更前（GC=2013-2015 年）和指南变更后（GC=2016-2021 年）执行的 TL 和 TT。再次手术包括甲状腺手术（RTS）和颈清扫术（ND）；时机被定义为早期（≥180天），被认为表明初始手术选择的不足，或晚期（>180天），表明疾病复发。结果 65,627 名患者中，31.8% 接受初始 TL，68.2% 接受初始 TT； TL 从 GC 前占总病例数的 21.4% 增加到 GC 后的 37.0% (p<0.001)。在 TL 患者中，早期 RTS 从 33.9%-14.2% 下降，ND 从 0.8%-0.4% 下降 (p<0.001)。在 TT 患者中，早期 RTS 仍为 0.2%，而 ND 则从 0.4%-0.7% 增加（p<0.001）。 TL 相关的晚期 RTS 从 2.0%-1.7% 下降，而 ND 从 0.6%-0.8% 上升 (p=0.17)。在 TT 患者中，晚期 RTS 和 ND 均增加，分别从 0.2%-0.3% (p=0.04) 和 1.7%-2.1% (p<0.01) 增加。 GC 后 TL 与 TT 的晚期再手术率没有差异（0.2%，p=0.18）。高容量中心的 TL 容量每年增长 12.5% [8.9%-16.2%]，低容量中心的 TL 容量每年增长 8.3% [5.6%-11.1%]。高容量中心的 TL 相关再手术每年下降 12.6% [5.6%-19.0%]，低容量中心则每年下降 10.8% [2.7%-18.1%]。无保险状态和较新的初次手术与晚期再次手术的风险增加相关（分别为 HR=1.84 [1.06-3.20] 和 HR=1.30 [1.24-1.36]）。然而，所进行的索引手术类型并不能预测后期再次手术。结论 2015 年 ATA 指南发布后，甲状腺叶切除术的早期再手术率有所下降，但晚期再手术率保持不变，尽管实践模式发生了显着转变，开始进行初次肺叶切除术。与甲状腺全切除术相比，患者接受的治疗似乎不太积极，且符合指南，但甲状腺叶切除术的晚期再手术率并未显着增加。

Introduction The 2015 ATA guidelines recommended thyroid lobectomy (TL) as an alternative to total thyroidectomy (TT) for the surgical treatment of low-risk differentiated thyroid cancer. Increasing use of TL has since been reported despite concerns for an increased risk of disease recurrence and need for reoperation. This study sought to compare reoperation rates among patients who underwent initial TL or TT for malignancy, characterize trends at centers based on operative volume, and examine factors associated with reoperation. Methods We queried the Vizient Clinical Data Base for TL and TT performed pre-guideline change (pre-GC=2013-2015) and post-guideline change (post-GC=2016-2021). Reoperations included reoperative thyroid surgery (RTS) and neck dissection (ND); timing was defined as early (180 days), thought to indicate inadequacy of initial operative choice, or late (>180 days), suggesting disease recurrence. Results Of 65,627 patients, 31.8% underwent initial TL and 68.2% underwent initial TT; TL increased from 21.4% of total cases pre-GC to 37.0% post-GC (p<0.001). Among TL patients, early RTS declined from 33.9%-14.2% and ND declined from 0.8%-0.4% (p<0.001). Among TT patients, early RTS remained 0.2%, while ND increased from 0.4%-0.7% (p<0.001). TL-associated late RTS declined from 2.0%-1.7%, while ND increased from 0.6%-0.8% (p=0.17). In TT patients, both late RTS and ND increased, from 0.2%-0.3% (p=0.04) and 1.7%-2.1% (p<0.01), respectively. There was no difference in the late reoperation rate for TL compared to TT post-GC (+0.2%, p=0.18). TL volume grew annually by 12.5% [8.9%-16.2%] at high-volume centers and 8.3% [5.6%-11.1%] at low-volume centers. TL-associated reoperations at high-volume centers declined annually by 12.6% [5.6%-19.0%] and 10.8% [2.7%-18.1%] at low-volume centers. Uninsured status and more recent initial operation were associated with an increased risk of late reoperation (HR=1.84 [1.06-3.20] and HR=1.30 [1.24-1.36], respectively). The type of index operation performed, however, was not predictive of late reoperation. Conclusions The rate of early reoperations declined for thyroid lobectomy after the 2015 ATA guideline release but late reoperations remained unchanged despite a significant shift in practice patterns towards performing initial lobectomy. Patients appear to be receiving less aggressive, guideline-concordant care without a significant increase in the late reoperation rate for thyroid lobectomy compared to total thyroidectomy.