title: Impact of American College of Surgeons Oncology Group Z11 on surgical training at an academic cancer center.
abstract: BACKGROUND
  The application of the American College of Surgeons Oncology Group Z0011 trial (Z11) has resulted in fewer completion axillary lymph node dissections (ALNDs) for select patients. We hypothesize that the application of Z11 may result in fewer ALND cases for surgeons in training.
  
  
  METHODS
  In the setting of an academic cancer center incorporating Z11 into routine practice, we compared the total number of ALND performed in a pre-Z11 period (January 2007-April 2011, 52 mo) and post-Z11 period (April 2011-February 2014, 34 mo). We also identified the number of patients in the post-Z11 era in whom ALND was omitted as a result of Z11. Clinical and pathologic characteristics among these groups were analyzed.
  
  
  RESULTS
  A total of 279 and 191 ALNDs were performed in the pre-Z11 and post-Z11 groups, respectively. Variables were similar among these groups with respect to demographics, tumor characteristics, and surgeries performed. There was no difference in the monthly rates of ALND between groups-5.37 cases/mo (pre-Z11) and 5.62 cases/mo (post-Z11), P = 0.52. We identified a total of 53 patients for whom ALND was omitted due to Z11 application in the post-Z11 period, representing a potential 21.7% decrease (53/191 + 53) in the number of ALNDs in this period.
  
  
  CONCLUSIONS
  Although the application of Z11 could potentially impact surgical training with a 21.7% decrease in ALND cases (53/191 + 53), the surgical case volume at an academic cancer center absorbs this decrease and maintains consistent levels of training for ALND.
authors.affiliation: Department of Surgical Oncology, Roswell Park Cancer Institute, Buffalo, New York.
authors.forename: Emmanuel
authors.initials: E
authors.lastname: Gabriel
authors.affiliation: Department of Biostatistics, Roswell Park Cancer Institute, Buffalo, New York.
authors.forename: Kristopher
authors.initials: K
authors.lastname: Attwood
authors.affiliation: Department of Surgical Oncology, Roswell Park Cancer Institute, Buffalo, New York.
authors.forename: Jessica
authors.initials: J
authors.lastname: Young
authors.affiliation: Department of Surgical Oncology, Roswell Park Cancer Institute, Buffalo, New York.
authors.forename: Helen
authors.initials: H
authors.lastname: Cappuccino
authors.affiliation: Department of Surgical Oncology, Roswell Park Cancer Institute, Buffalo, New York. Electronic address: shicha.kumar@roswellpark.org.
authors.forename: Shicha
authors.initials: S
authors.lastname: Kumar
mesh_terms: D000046:Academic Medical Centers / Q000706:statistics & numerical data*; D000328:Adult; D000368:Aged; D001365:Axilla / Q000601:surgery; D005260:Female; D013502:General Surgery / Q000193:education* / Q000706:statistics & numerical data; D006801:Humans; D008197:Lymph Node Excision / Q000706:statistics & numerical data*; D008875:Middle Aged; D009518:New York
keywords: Axillary lymph node dissection; Surgical training; Z11