Perioperative cost reduction by implementation of ACOSOG Z0011 criteria

Abstract

Introduction: Breast cancer patients with positive sentinel lymph nodes (SLNs) traditionally will undergo completion axillary dissection (ALND). The ACOSOG Z0011 trial has shown that those who underwent breast conservative surgery but did not undergo ALND did not fare worse compared to the ALND group when the axillary nodal burden is low. The aim of this study is to evaluate the change in peri‐operative costs with application of Z0011 guidelines. Methods: A retrospective analysis from our prospectively maintained database at a University affiliated government subsidized breast cancer centre was performed. Patients who received upfront breast conservative surgery with sentinel lymph node biopsy (SLNB) between January 2010 to June 2019 were included. A peri‐operative cost analysis was performed. Results: There were 491 patients in our cohort. Sixteen patients were excluded as their sentinel lymph nodes were positive on immunohistochemistry only. All patients received intraoperative frozen section of SLNs. One hundred and six patients had at least one positive SLN on final histology. Applying the Z0011 criteria, seventy‐five patients (70.8%) met the ACOSOG Z0011 criteria for omission of ALND and 31 patients (29.2%) would have required a delayed completion ALND. Around HKD 3400 per patient could have been saved with the reduction in intraoperative frozen and ALND (cost of processing frozen section and dispensable operative costs). This could also translate into a 63% reduction in overnight hospital stay. Conclusions: Application of Z0011 guidelines result allows less intraoperative frozen section and ALND, and is associated with a reduction of peri‐operative costs.