{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,3]],"date-time":"2026-09-03T03:12:47Z","timestamp":1788405167487,"version":"build-2803163510"},"reference-count":30,"publisher":"SAGE Publications","issue":"6","license":[{"start":{"date-parts":[[2026,4,9]],"date-time":"2026-04-09T00:00:00Z","timestamp":1775692800000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"funder":[{"name":"Korean Thyroid Association","award":["Outstanding Investigator Award 2023"],"award-info":[{"award-number":["Outstanding Investigator Award 2023"]}]},{"DOI":"10.13039\/501100003725","name":"National Research Foundation of Korea","doi-asserted-by":"crossref","award":["RS-2020-NR047825"],"award-info":[{"award-number":["RS-2020-NR047825"]}],"id":[{"id":"10.13039\/501100003725","id-type":"DOI","asserted-by":"crossref"}]},{"DOI":"10.13039\/501100003725","name":"National Research Foundation of Korea","doi-asserted-by":"crossref","award":["RS-2023-NR076402"],"award-info":[{"award-number":["RS-2023-NR076402"]}],"id":[{"id":"10.13039\/501100003725","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Thyroid\u00ae"],"published-print":{"date-parts":[[2026,6,1]]},"abstract":"<jats:sec>\n                    <jats:title>Background:<\/jats:title>\n                    <jats:p>The American Thyroid Association (ATA) guideline revisions in 2009 and 2015 encouraged a shift toward less extensive surgery and reduced use of radioactive iodine (RAI) in the management of patients with low-risk papillary thyroid carcinoma (PTC). The aim of this study was to evaluate the real-world impact of these guideline changes on treatment patterns, complications, and oncologic outcomes.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods:<\/jats:title>\n                    <jats:p>In this retrospective cohort study conducted at a high-volume tertiary center in South Korea, we analyzed 31,861 patients treated for PTCs measuring \u22644 cm during 2004\u20132020. Patients were stratified into three temporal cohorts (triad 0 2004\u20132009; triad 1: 2010\u20132015; and triad 2: 2016\u20132020), and exact matching was performed to balance clinicopathologic characteristics across the groups. Segmented regression analysis was used to identify treatment pattern shifts. Postoperative complications and disease-free survival (DFS) were compared across the matched cohorts by using conditional logistic and stratified Cox regression analyses. Five-year restricted mean survival time (RMST) analysis was performed to adjust for follow-up variation.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>\n                      After guideline implementation, total thyroidectomies and RAI use significantly declined. Permanent hypocalcemia decreased from 2.7% to 0.2% (\n                      <jats:italic toggle=\"yes\">p<\/jats:italic>\n                      &lt; 0.001) while transient complications remained stable. Although recurrence rates were lowest in the most recent era (1.3%), DFS analysis revealed higher hazard ratios for recurrence in triad 2 versus earlier cohorts (triad 2 vs. 0 hazard ratio: 1.520, confidence interval: 1.160\u20131.980). However, 5-year DFS and RMST comparisons revealed no significant differences.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions:<\/jats:title>\n                    <jats:p>ATA guideline-driven de-escalation strategies were successfully implemented in real-world practice in this study, reducing overtreatment and surgical morbidity without compromising short-term oncologic outcomes.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/10507256261442841","type":"journal-article","created":{"date-parts":[[2026,4,9]],"date-time":"2026-04-09T09:38:30Z","timestamp":1775727510000},"page":"609-619","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":0,"title":["A Temporal Analysis of Surgical Management and Outcomes Following ATA Guideline Updates in Papillary Thyroid Carcinoma: A Real-World Cohort Study of 31,861 Patients in South Korea"],"prefix":"10.1177","volume":"36","author":[{"given":"Jae Sang","family":"Ryu","sequence":"first","affiliation":[{"name":"Department of Surgery, Open NBI Convergence Technology Research Laboratory, Yonsei Cancer Center, Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eun Jin","family":"Kim","sequence":"additional","affiliation":[{"name":"Department of Surgery, Open NBI Convergence Technology Research Laboratory, Yonsei Cancer Center, Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"In A.","family":"Lee","sequence":"additional","affiliation":[{"name":"Department of Surgery, Gimpo Woori Hospital, Gyeonggi-do, South Korea."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dong Wook","family":"Kim","sequence":"additional","affiliation":[{"name":"Department of Surgery, Gimpo Woori Hospital, Gyeonggi-do, South Korea."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ji An","family":"Lee","sequence":"additional","affiliation":[{"name":"Department of Surgery, Open NBI Convergence Technology Research Laboratory, Yonsei Cancer Center, Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dong Hyun","family":"Seo","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Open NBI Convergence Technology Research Laboratory, Yonsei University College of Medicine, Seoul, South Korea."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ji Ahn","family":"Park","sequence":"additional","affiliation":[{"name":"Department of Surgery, Open NBI Convergence Technology Research Laboratory, Yonsei Cancer Center, Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sunmi","family":"Park","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Open NBI Convergence Technology Research Laboratory, Yonsei University College of Medicine, Seoul, South Korea."},{"name":"Endocrine Research Institute, Yonsei University College of Medicine, Seoul, South Korea."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sungkeun","family":"Kang","sequence":"additional","affiliation":[{"name":"Department of Surgery, Open NBI Convergence Technology Research Laboratory, Yonsei Cancer Center, Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sang Wook","family":"Kang","sequence":"additional","affiliation":[{"name":"Department of Surgery, Open NBI Convergence Technology Research Laboratory, Yonsei Cancer Center, Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea."},{"name":"Endocrine Research Institute, Yonsei University College of Medicine, Seoul, South Korea."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jong Ju","family":"Jeong","sequence":"additional","affiliation":[{"name":"Department of Surgery, Open NBI Convergence Technology Research Laboratory, Yonsei Cancer Center, Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea."},{"name":"Endocrine Research Institute, Yonsei University College of Medicine, Seoul, South Korea."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kee Hyun","family":"Nam","sequence":"additional","affiliation":[{"name":"Department of Surgery, Open NBI Convergence Technology Research Laboratory, Yonsei Cancer Center, Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea."},{"name":"Endocrine Research Institute, Yonsei University College of Medicine, Seoul, South Korea."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Woong Youn","family":"Chung","sequence":"additional","affiliation":[{"name":"Department of Surgery, Open NBI Convergence Technology Research Laboratory, Yonsei Cancer Center, Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea."},{"name":"Endocrine Research Institute, Yonsei University College of Medicine, Seoul, South Korea."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9926-8389","authenticated-orcid":false,"given":"Young Suk","family":"Jo","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Open NBI Convergence Technology Research Laboratory, Yonsei University College of Medicine, Seoul, South Korea."},{"name":"Endocrine Research Institute, Yonsei University College of Medicine, Seoul, South 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