ArticleJournal of surgical education2025
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.
Article in Journal of surgical education, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
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Authors and funding
6 authors.
Funding
Abstract
objectiveTo assess the impact of axillary surgery de-escalation trends on general surgery resident and breast surgical oncology fellow exposure to axillary lymph node dissection cases.
designAccreditation Council for Graduate Medical Education case logs were retrospectively analyzed with attention to change over time. Trends in axillary lymph node dissection were evaluated using univariate linear regression.
settingAcademic, tertiary medical center with a large general surgery residency and multiple surgical fellowship programs.
participantsGeneral surgery residents and breast surgical oncology fellows graduating from 2009-2024.
resultsAxillary lymph node dissection experience is decreasing for general surgery residents (estimate -0.46 cases per resident/graduation year, 95% CI -0.73, -0.19; p = 0.0011), with a mean of 12.0 cases per resident graduating in 2010 versus 6.1 cases in those graduating in 2024. Sentinel lymph node experience is preserved. Fellow axillary lymph node dissection experience is stable (p = 0.20) with a mean of 21.3 cases, however more recent fellow graduates have total numbers less than 20 cases.
conclusionsThe decrease in use of axillary lymph node dissection in clinical practice parallels a decline in resident experience with axillary lymph node dissection while fellow experience appears preserved. Continued attention to trends along with intentional case assignment and alternate/supplemental methods of education, such as video and simulation, may be valuable to educate residents on axillary lymph node dissection.
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