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American College of Surgeons Oncology Group (ACOSOG) Z0011: impact on surgeon practice patterns

Abigail S Caudle1, Kelly K Hunt, Susan L Tucker

  • 1Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA. ascaudle@mdanderson.org

Annals of Surgical Oncology
|August 1, 2012
PubMed
Abstract

Insights

The ACOSOG Z0011 trial significantly changed surgical practices, reducing axillary lymph node dissection (ALND) rates and operative times for breast cancer patients. Surgeons now consider clinicopathologic factors, but Z0011

Area of Science:

  • Surgical Oncology
  • Breast Cancer Management
  • Clinical Trial Impact Assessment

Background:

  • The ACOSOG Z0011 trial is recognized as a practice-changing study in breast cancer management.
  • This study aimed to evaluate the influence of the Z0011 trial findings on surgeon practices at a specific institution.

Purpose of the Study:

  • To assess the impact of the ACOSOG Z0011 trial on surgeon practice patterns.
  • To compare surgical decisions and outcomes before and after the dissemination of Z0011 trial results.

Main Methods:

  • A retrospective review of practice patterns was conducted, comparing the year prior to the Z0011 trial release with the year after institutional discussion of its results.
  • Patients meeting the inclusion criteria for the Z0011 trial were identified.
  • Clinicopathologic data were collected and compared between the pre-Z0011 and post-Z0011 cohorts.

Main Results:

  • Following the Z0011 trial, there was a significant decrease in axillary lymph node dissection (ALND) rates for sentinel lymph node (SLN) positive patients (85% pre-Z0011 vs. 24% post-Z0011, p < 0.001).
  • Surgeons were less likely to perform intraoperative nodal assessment post-Z0011 (26% vs. 69%, p < 0.001), leading to decreased operative times for SLN-negative patients.
  • Clinicopathologic factors such as tumor size, histology, and metastasis characteristics continued to influence the decision to perform ALND.

Conclusions:

  • Surgeons at the institution have largely adopted the ACOSOG Z0011 trial recommendations into their practice.
  • The Z0011 trial has demonstrably reduced ALND rates, intraoperative nodal evaluation, and overall operative times.
  • While practice patterns have shifted, clinical and pathological factors still play a role in the decision-making process for ALND.

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