ArticleAmerican journal of surgery2019
Decreasing rates of axillary lymph node dissections over time: Implications for surgical resident exposure and operative skills development.
Article in American journal of surgery, 2019. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 14 papers, 1 of them a synthesis that pooled it.
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Who cites it
14 citing papers in PubMed, 1 synthesis or guideline pooled it.
- Deimplementation of the Choosing Wisely Recommendations for Low-Value Breast Cancer Surgery: A Systematic Review.JAMA surgery · 2020Pooled it
- Surgical Trainee Familiarity and Knowledge of the Commission on Cancer Operative Standards: A National Survey Study.Journal of the American College of Surgeons · 2026Article
- ALND Experience During Breast Surgical Oncology Fellowship over the Years: An SSO/ASBrS Collaborative Analysis.Annals of surgical oncology · 2026Article
- Contemporary Trends in Axillary Surgery for ER-Positive, HER2-Negative Breast Cancer Stratified by Neoadjuvant Endocrine Therapy, Neoadjuvant Chemotherapy, or Upfront Surgery.Annals of surgical oncology · 2026Article
- Does De-Escalation of Axillary Surgery Impact Surgical Trainee Experience? A 15-Year Institutional Analysis of General Surgery Resident and Breast Surgical Oncology Fellow Operative Volumes.Journal of surgical education · 2025Article
- BJS commission on the surgical management of the axilla in breast cancer.The British journal of surgery · 2025Article
- The yield of axillary clearance in breast cancer in Khartoum locality -Sudan: a cross-sectional study.Annals of medicine and surgery (2012) · 2025Article
- External Validation of a 5-Factor Risk Model for Breast Cancer-Related Lymphedema.JAMA network open · 2025Article
- Utilising the Flap Vein of a Pedicled TRAM Flap for LYMPHA: A Case Report.World journal of plastic surgery · 2025Article
- American College of Surgeons Operative Standards and Breast Cancer Outcomes.JAMA network open · 2024Article
- Does Neoadjuvant Chemotherapy in Clinical T1-T2 N0 Triple-Negative Breast Cancer Increase the Extent of Axillary Surgery?Annals of surgical oncology · 2024Article
- Comparison of survival outcomes between axillary conservation and axillary lymph node dissections in N1 early breast cancer: a propensity-matched SEER analysis.Clinical & translational oncology : official publication of the Federation of Spanish Oncology Societies and of the National Cancer Institute of Mexico · 2023Article
- A National Survey of Breast Surgeons and Radiation Oncologists on Contemporary Axillary Management in Mastectomy Patients.Annals of surgical oncology · 2021Article
- Effect of perioperative pain neuroscience education in patients with post-mastectomy persistent pain: a retrospective, propensity score-matched study.Supportive care in cancer : official journal of the Multinational Association of Supportive Care in Cancer · 2021Article
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Authors and funding
7 authors.
Funding
Abstract
backgroundSentinel lymph node biopsy has supplanted axillary lymph node dissection (ALND) in clinically node-negative breast cancer and select node-positive disease. We hypothesized a decreasing rate of both ALND and resident exposure over time.
methodsWe identified women with clinical Stage I-III breast cancer in the National Cancer Data Base (2004-2014). Adjusted multivariate logistic regression was used to estimate the effect of various factors on receipt of ALND. Yearly procedural rates for residents were extracted from surgical case log reports for comparison against procedural rates.
results1,131,363 patients were identified; 255,306 received ALND, 876,057 underwent non-ALND management. ALND rates declined from 2004 (32%) to 2014 (16%, p < 0.001), with the largest decline occurring between 2010 and 2011 (24%-20%). After adjustment, this effect was maintained, with ALND rates decreasing with each additional year (OR = 0.90, 95% CI 0.89-0.90). Resident procedure volumes similarly declined from 1999 to 2017 (p < 0.001).
conclusionsSignificant declines in both ALND rates and procedural volume in residency may impact outcomes, as ALNDs are being performed in ever more challenging oncologic scenarios by potentially less-experienced surgeons.
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