Division of Surgical Oncology, Massachusetts General Hospital, Boston, MA, USA.
Ann Surg Oncol. 2013 Mar;20(3):836-41. doi: 10.1245/s10434-012-2664-0. Epub 2012 Sep 26.
The ACOSOG Z0011 (Z0011) trial concluded that sentinel lymph node biopsy (SLNB) without completion axillary lymph node dissection (ALND) provides excellent regional control in women with T1-T2 sentinel lymph node (SLN) positive breast cancers receiving breast conservation therapy. We determined whether application of Z0011 guidelines would reduce costs.
A retrospective chart review of patients with invasive breast cancer treated with lumpectomy and SLNB at our institution during 2009 was performed. We determined the number of overnight hospital admissions following ALND and estimated costs pertaining to the perioperative surgical management of the axilla patients actually received, and compared those to the estimated number of inpatient days and perioperative costs if Z0011 guidelines had been followed for eligible patients. The 2011 Medicare Fee Schedule was used to estimate costs for procedures, and costs for OR time were estimated using procedure length and cost of OR time per minute.
A total of 71 patients underwent lumpectomy with SLNB and had at least 1 positive SLN. Estimated costs related to perioperative surgical management of the axilla were $322,775, and there were 36 overnight admissions. Applying Z0011 criteria, 51 patients (72%) would have been eligible to forego completion ALND. Estimated costs would have been $264,513 with 13 overnight admissions, translating into a cost savings of $58,262 and 23 fewer overnight admissions.
Application of Z0011 guidelines resulted in cost savings, with a 64% reduction in inpatient hospital days and an 18% reduction in early perioperative costs.
ACOSOG Z0011（Z0011）试验得出结论，对于接受保乳治疗的 T1-T2 期前哨淋巴结阳性乳腺癌患者，前哨淋巴结活检（SLNB）而不进行完整腋窝淋巴结清扫术（ALND）可提供出色的区域控制。我们确定是否应用 Z0011 指南会降低成本。
我们对 2009 年在我们机构接受保乳切除术和 SLNB 治疗的浸润性乳腺癌患者进行了回顾性图表审查。我们确定了进行 ALND 后需要过夜住院的人数，并估计了与实际接受的腋窝患者围手术期管理相关的成本，然后将这些与如果符合条件的患者遵循 Z0011 指南则估计的住院天数和围手术期成本进行了比较。2011 年 Medicare 费用表用于估计手术程序的费用，并且使用手术时间和每分钟手术间成本来估计 OR 时间的成本。
共有 71 名患者接受了保乳术和 SLNB，并且至少有 1 个前哨淋巴结阳性。与腋窝围手术期管理相关的估计成本为 322,775 美元，有 36 名患者需要过夜住院。应用 Z0011 标准，51 名患者（72％）有资格避免完成 ALND。估计成本将为 264,513 美元，有 13 名患者需要过夜住院，从而节省了 58,262 美元，并减少了 23 次过夜住院。
应用 Z0011 指南可节省成本，减少 64％的住院天数，并减少 18％的早期围手术期成本。
