Cost comparison of axillary sentinel lymph node detection and axillary lymphadenectomy in early breast cancer. A national study based on a prospective multi-institutional series of 985 patients ‘on behalf of the Group of Surgeons from the French Unicancer Federation’
Identifieur interne : 000289 ( France/Analysis ); précédent : 000288; suivant : 000290Cost comparison of axillary sentinel lymph node detection and axillary lymphadenectomy in early breast cancer. A national study based on a prospective multi-institutional series of 985 patients ‘on behalf of the Group of Surgeons from the French Unicancer Federation’
Auteurs : J. M. Classe ; S. Baffert [France] ; B. Sigal-Zafrani [France] ; M. Fall [France] ; C. Rousseau ; S. Alran [France] ; P. Rouanet ; C. Belichard ; H. Mignotte [France] ; G. Ferron [France] ; F. Marchal [France] ; S. Giard ; C. Tunon De Lara ; G. Le Bouedec ; J. Cuisenier ; R. Werner ; I. Raoust ; J.-F. Rodier [France] ; F. Laki [France] ; P.-E. Colombo ; S. Lasry ; C. Faure [France] ; H. Charitansky [France] ; J.-B. Olivier [France] ; M.-P. Chauvet ; E. Bussières ; P. Gimbergues ; B. Flipo ; G. Houvenaeghel [France] ; F. Dravet ; A. Livartowski [France]Source :
- Annals of Oncology [ 0923-7534 ] ; 2011.
Abstract
Our objective was to assess the global cost of the sentinel lymph node detection [axillary sentinel lymph node detection (ASLND)] compared with standard axillary lymphadenectomy [axillary lymph node dissection (ALND)] for early breast cancer patients.
We conducted a prospective, multi-institutional, observational, cost comparative analysis. Cost calculations were realized with the micro-costing method from the diagnosis until 1 month after the last surgery.
Eight hundred and thirty nine patients were included in the ASLND group and 146 in the ALND group. The cost generated for a patient with an ASLND, with one preoperative scintigraphy, a combined method for sentinel node detection, an intraoperative pathological analysis without lymphadenectomy, was lower than the cost generated for a patient with lymphadenectomy [€2947 (σ = 580) versus €3331 (σ = 902);
ASLND, involving expensive techniques, was finally less expensive than ALND. The length of hospital stay was the cost driver of these procedures. The current observational study points the heterogeneous practices for this validated and largely diffused technique. Several technical choices have an impact on the cost of ASLND, as intraoperative analysis allowing to reduce rehospitalization rate for secondary lymphadenectomy or preoperative scintigraphy, suggesting possible savings on hospital resources.
Url:
DOI: 10.1093/annonc/mdr355
PubMed: 21896543
PubMed Central: 3335244
Affiliations:
- France
- Alsace (région administrative), Auvergne-Rhône-Alpes, Grand Est, Lorraine (région), Midi-Pyrénées, Occitanie (région administrative), Rhône-Alpes, Île-de-France
- Lyon, Nancy, Paris, Strasbourg, Toulouse
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Baffert</name><affiliation wicri:level="3"><nlm:aff id="aff2">Medico economic unit, Institut Curie, Paris</nlm:aff><country>France</country><placeName><settlement type="city">Paris</settlement><region type="région" nuts="2">Île-de-France</region></placeName><wicri:orgArea>Medico economic unit, Institut Curie</wicri:orgArea></affiliation></author><author><name sortKey="Sigal Zafrani, B" sort="Sigal Zafrani, B" uniqKey="Sigal Zafrani B" first="B." last="Sigal-Zafrani">B. Sigal-Zafrani</name><affiliation wicri:level="3"><nlm:aff id="aff3">Pathology Department, Institut Curie, Paris</nlm:aff><country>France</country><placeName><settlement type="city">Paris</settlement><region type="région" nuts="2">Île-de-France</region></placeName><wicri:orgArea>Pathology Department, Institut Curie</wicri:orgArea></affiliation></author><author><name sortKey="Fall, M" sort="Fall, M" uniqKey="Fall M" first="M." last="Fall">M. Fall</name><affiliation wicri:level="3"><nlm:aff id="aff2">Medico economic unit, Institut Curie, Paris</nlm:aff><country>France</country><placeName><settlement type="city">Paris</settlement><region type="région" nuts="2">Île-de-France</region></placeName><wicri:orgArea>Medico economic unit, Institut Curie</wicri:orgArea></affiliation></author><author><name sortKey="Rousseau, C" sort="Rousseau, C" uniqKey="Rousseau C" first="C." last="Rousseau">C. Rousseau</name><affiliation><nlm:aff id="aff4">Nuclear medicine Department, Institut de Cancérologie de l'Ouest-Center Gauducheau, Nantes</nlm:aff><wicri:noCountry code="subfield">Nantes</wicri:noCountry></affiliation></author><author><name sortKey="Alran, S" sort="Alran, S" uniqKey="Alran S" first="S." last="Alran">S. Alran</name><affiliation wicri:level="3"><nlm:aff id="aff5">Surgical Department, Institut Curie, Paris</nlm:aff><country>France</country><placeName><settlement type="city">Paris</settlement><region type="région" nuts="2">Île-de-France</region></placeName><wicri:orgArea>Surgical Department, Institut Curie</wicri:orgArea></affiliation></author><author><name sortKey="Rouanet, P" sort="Rouanet, P" uniqKey="Rouanet P" first="P." last="Rouanet">P. Rouanet</name><affiliation><nlm:aff id="aff6">Surgical Department, Center Val d'Aurel Montpellier</nlm:aff><wicri:noCountry code="subfield">Center Val d'Aurel Montpellier</wicri:noCountry></affiliation></author><author><name sortKey="Belichard, C" sort="Belichard, C" uniqKey="Belichard C" first="C." last="Belichard">C. Belichard</name><affiliation><nlm:aff id="aff7">Surgical Department, Center René Huguenin, Saint Cloud</nlm:aff><wicri:noCountry code="subfield">Saint Cloud</wicri:noCountry></affiliation></author><author><name sortKey="Mignotte, H" sort="Mignotte, H" uniqKey="Mignotte H" first="H." last="Mignotte">H. Mignotte</name><affiliation wicri:level="3"><nlm:aff id="aff8">Surgical Department, Center Léon Bérard, Lyon</nlm:aff><country>France</country><placeName><settlement type="city">Lyon</settlement><region type="region" nuts="2">Auvergne-Rhône-Alpes</region><region type="old region" nuts="2">Rhône-Alpes</region></placeName><wicri:orgArea>Surgical Department, Center Léon Bérard</wicri:orgArea></affiliation></author><author><name sortKey="Ferron, G" sort="Ferron, G" uniqKey="Ferron G" first="G." last="Ferron">G. Ferron</name><affiliation wicri:level="3"><nlm:aff id="aff9">Surgical Department, Institut Claudius Regaud, Toulouse</nlm:aff><country>France</country><placeName><settlement type="city">Toulouse</settlement><region type="region" nuts="2">Occitanie (région administrative)</region><region type="old region" nuts="2">Midi-Pyrénées</region></placeName><wicri:orgArea>Surgical Department, Institut Claudius Regaud</wicri:orgArea></affiliation></author><author><name sortKey="Marchal, F" sort="Marchal, F" uniqKey="Marchal F" first="F." last="Marchal">F. Marchal</name><affiliation wicri:level="3"><nlm:aff id="aff10">Surgical Department, Center Alexis Vautrin, Nancy</nlm:aff><country>France</country><placeName><settlement type="city">Nancy</settlement><region type="region" nuts="2">Grand Est</region><region type="old region" nuts="2">Lorraine (région)</region></placeName><wicri:orgArea>Surgical Department, Center Alexis Vautrin</wicri:orgArea></affiliation></author><author><name sortKey="Giard, S" sort="Giard, S" uniqKey="Giard S" first="S." last="Giard">S. Giard</name><affiliation><nlm:aff id="aff11">Surgical Department, Center Oscar Lambret, Lille</nlm:aff><wicri:noCountry code="subfield">Lille</wicri:noCountry></affiliation></author><author><name sortKey="Tunon De Lara, C" sort="Tunon De Lara, C" uniqKey="Tunon De Lara C" first="C." last="Tunon De Lara">C. Tunon De Lara</name><affiliation><nlm:aff id="aff12">Surgical Department, Center Bergonié, Bordeaux</nlm:aff><wicri:noCountry code="subfield">Bordeaux</wicri:noCountry></affiliation></author><author><name sortKey="Le Bouedec, G" sort="Le Bouedec, G" uniqKey="Le Bouedec G" first="G." last="Le Bouedec">G. Le Bouedec</name><affiliation><nlm:aff id="aff13">Surgical Department, Center Jean Perrin, Clermont Ferrand</nlm:aff><wicri:noCountry code="subfield">Clermont Ferrand</wicri:noCountry></affiliation></author><author><name sortKey="Cuisenier, J" sort="Cuisenier, J" uniqKey="Cuisenier J" first="J." last="Cuisenier">J. Cuisenier</name><affiliation><nlm:aff id="aff14">Surgical Department, Center Georges François Leclerc, Dijon</nlm:aff><wicri:noCountry code="subfield">Dijon</wicri:noCountry></affiliation></author><author><name sortKey="Werner, R" sort="Werner, R" uniqKey="Werner R" first="R." last="Werner">R. Werner</name><affiliation><nlm:aff id="aff15">Surgical Department, Center Jean Godinot, Reims</nlm:aff><wicri:noCountry code="subfield">Reims</wicri:noCountry></affiliation></author><author><name sortKey="Raoust, I" sort="Raoust, I" uniqKey="Raoust I" first="I." last="Raoust">I. Raoust</name><affiliation><nlm:aff id="aff16">Surgical Department, Center Georges Lacassagne, Nice</nlm:aff><wicri:noCountry code="subfield">Nice</wicri:noCountry></affiliation></author><author><name sortKey="Rodier, J F" sort="Rodier, J F" uniqKey="Rodier J" first="J.-F." last="Rodier">J.-F. Rodier</name><affiliation wicri:level="3"><nlm:aff id="aff17">Surgical Department, Center Paul Strauss, Strasbourg</nlm:aff><country>France</country><placeName><settlement type="city">Strasbourg</settlement><region type="region" nuts="2">Grand Est</region><region type="old region" nuts="2">Alsace (région administrative)</region></placeName><wicri:orgArea>Surgical Department, Center Paul Strauss</wicri:orgArea></affiliation></author><author><name sortKey="Laki, F" sort="Laki, F" uniqKey="Laki F" first="F." last="Laki">F. Laki</name><affiliation wicri:level="3"><nlm:aff id="aff2">Medico economic unit, Institut Curie, Paris</nlm:aff><country>France</country><placeName><settlement type="city">Paris</settlement><region type="région" nuts="2">Île-de-France</region></placeName><wicri:orgArea>Medico economic unit, Institut Curie</wicri:orgArea></affiliation><affiliation wicri:level="3"><nlm:aff id="aff5">Surgical Department, Institut Curie, Paris</nlm:aff><country>France</country><placeName><settlement type="city">Paris</settlement><region type="région" nuts="2">Île-de-France</region></placeName><wicri:orgArea>Surgical Department, Institut Curie</wicri:orgArea></affiliation></author><author><name sortKey="Colombo, P E" sort="Colombo, P E" uniqKey="Colombo P" first="P.-E." last="Colombo">P.-E. Colombo</name><affiliation><nlm:aff id="aff6">Surgical Department, Center Val d'Aurel Montpellier</nlm:aff><wicri:noCountry code="subfield">Center Val d'Aurel Montpellier</wicri:noCountry></affiliation></author><author><name sortKey="Lasry, S" sort="Lasry, S" uniqKey="Lasry S" first="S." last="Lasry">S. Lasry</name><affiliation><nlm:aff id="aff7">Surgical Department, Center René Huguenin, Saint Cloud</nlm:aff><wicri:noCountry code="subfield">Saint Cloud</wicri:noCountry></affiliation></author><author><name sortKey="Faure, C" sort="Faure, C" uniqKey="Faure C" first="C." last="Faure">C. Faure</name><affiliation wicri:level="3"><nlm:aff id="aff8">Surgical Department, Center Léon Bérard, Lyon</nlm:aff><country>France</country><placeName><settlement type="city">Lyon</settlement><region type="region" nuts="2">Auvergne-Rhône-Alpes</region><region type="old region" nuts="2">Rhône-Alpes</region></placeName><wicri:orgArea>Surgical Department, Center Léon Bérard</wicri:orgArea></affiliation></author><author><name sortKey="Charitansky, H" sort="Charitansky, H" uniqKey="Charitansky H" first="H." last="Charitansky">H. Charitansky</name><affiliation wicri:level="3"><nlm:aff id="aff9">Surgical Department, Institut Claudius Regaud, Toulouse</nlm:aff><country>France</country><placeName><settlement type="city">Toulouse</settlement><region type="region" nuts="2">Occitanie (région administrative)</region><region type="old region" nuts="2">Midi-Pyrénées</region></placeName><wicri:orgArea>Surgical Department, Institut Claudius Regaud</wicri:orgArea></affiliation></author><author><name sortKey="Olivier, J B" sort="Olivier, J B" uniqKey="Olivier J" first="J.-B." last="Olivier">J.-B. Olivier</name><affiliation wicri:level="3"><nlm:aff id="aff10">Surgical Department, Center Alexis Vautrin, Nancy</nlm:aff><country>France</country><placeName><settlement type="city">Nancy</settlement><region type="region" nuts="2">Grand Est</region><region type="old region" nuts="2">Lorraine (région)</region></placeName><wicri:orgArea>Surgical Department, Center Alexis Vautrin</wicri:orgArea></affiliation></author><author><name sortKey="Chauvet, M P" sort="Chauvet, M P" uniqKey="Chauvet M" first="M.-P." last="Chauvet">M.-P. Chauvet</name><affiliation><nlm:aff id="aff11">Surgical Department, Center Oscar Lambret, Lille</nlm:aff><wicri:noCountry code="subfield">Lille</wicri:noCountry></affiliation></author><author><name sortKey="Bussieres, E" sort="Bussieres, E" uniqKey="Bussieres E" first="E." last="Bussières">E. Bussières</name><affiliation><nlm:aff id="aff12">Surgical Department, Center Bergonié, Bordeaux</nlm:aff><wicri:noCountry code="subfield">Bordeaux</wicri:noCountry></affiliation></author><author><name sortKey="Gimbergues, P" sort="Gimbergues, P" uniqKey="Gimbergues P" first="P." last="Gimbergues">P. Gimbergues</name><affiliation><nlm:aff id="aff13">Surgical Department, Center Jean Perrin, Clermont Ferrand</nlm:aff><wicri:noCountry code="subfield">Clermont Ferrand</wicri:noCountry></affiliation></author><author><name sortKey="Flipo, B" sort="Flipo, B" uniqKey="Flipo B" first="B." last="Flipo">B. Flipo</name><affiliation><nlm:aff id="aff16">Surgical Department, Center Georges Lacassagne, Nice</nlm:aff><wicri:noCountry code="subfield">Nice</wicri:noCountry></affiliation></author><author><name sortKey="Houvenaeghel, G" sort="Houvenaeghel, G" uniqKey="Houvenaeghel G" first="G." last="Houvenaeghel">G. Houvenaeghel</name><affiliation wicri:level="1"><nlm:aff id="aff18">Surgical Department, Institut Paoli Calmette Marseille, France</nlm:aff><country xml:lang="fr">France</country><wicri:regionArea>Surgical Department, Institut Paoli Calmette Marseille</wicri:regionArea><wicri:noRegion>Institut Paoli Calmette Marseille</wicri:noRegion><wicri:noRegion>Institut Paoli Calmette Marseille</wicri:noRegion></affiliation></author><author><name sortKey="Dravet, F" sort="Dravet, F" uniqKey="Dravet F" first="F." last="Dravet">F. Dravet</name><affiliation><nlm:aff id="aff1">Surgical Department, Institut de Cancérologie de l'Ouest-Center Gauducheau, Nantes</nlm:aff><wicri:noCountry code="subfield">Nantes</wicri:noCountry></affiliation></author><author><name sortKey="Livartowski, A" sort="Livartowski, A" uniqKey="Livartowski A" first="A." last="Livartowski">A. Livartowski</name><affiliation wicri:level="3"><nlm:aff id="aff2">Medico economic unit, Institut Curie, Paris</nlm:aff><country>France</country><placeName><settlement type="city">Paris</settlement><region type="région" nuts="2">Île-de-France</region></placeName><wicri:orgArea>Medico economic unit, Institut Curie</wicri:orgArea></affiliation></author></titleStmt><publicationStmt><idno type="wicri:source">PMC</idno><idno type="pmid">21896543</idno><idno type="pmc">3335244</idno><idno type="url">http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3335244</idno><idno type="RBID">PMC:3335244</idno><idno type="doi">10.1093/annonc/mdr355</idno><date when="2011">2011</date><idno type="wicri:Area/Pmc/Corpus">002C16</idno><idno type="wicri:explorRef" wicri:stream="Pmc" wicri:step="Corpus" wicri:corpus="PMC">002C16</idno><idno type="wicri:Area/Pmc/Curation">002C15</idno><idno type="wicri:explorRef" wicri:stream="Pmc" wicri:step="Curation">002C15</idno><idno type="wicri:Area/Pmc/Checkpoint">003024</idno><idno type="wicri:explorRef" wicri:stream="Pmc" wicri:step="Checkpoint">003024</idno><idno type="wicri:Area/Ncbi/Merge">004649</idno><idno type="wicri:Area/Ncbi/Curation">004649</idno><idno type="wicri:Area/Ncbi/Checkpoint">004649</idno><idno type="wicri:doubleKey">0923-7534:2011:Classe J:cost:comparison:of</idno><idno type="wicri:Area/Main/Merge">005012</idno><idno type="wicri:Area/Main/Curation">004F76</idno><idno type="wicri:Area/Main/Exploration">004F76</idno><idno type="wicri:Area/France/Extraction">000289</idno></publicationStmt><sourceDesc><biblStruct><analytic><title xml:lang="en" level="a" type="main">Cost comparison of axillary sentinel lymph node detection and axillary lymphadenectomy in early breast cancer. A national study based on a prospective multi-institutional series of 985 patients ‘on behalf of the Group of Surgeons from the French Unicancer Federation’</title><author><name sortKey="Classe, J M" sort="Classe, J M" uniqKey="Classe J" first="J. M." last="Classe">J. M. Classe</name><affiliation><nlm:aff id="aff1">Surgical Department, Institut de Cancérologie de l'Ouest-Center Gauducheau, Nantes</nlm:aff><wicri:noCountry code="subfield">Nantes</wicri:noCountry></affiliation></author><author><name sortKey="Baffert, S" sort="Baffert, S" uniqKey="Baffert S" first="S." last="Baffert">S. Baffert</name><affiliation wicri:level="3"><nlm:aff id="aff2">Medico economic unit, Institut Curie, Paris</nlm:aff><country>France</country><placeName><settlement type="city">Paris</settlement><region type="région" nuts="2">Île-de-France</region></placeName><wicri:orgArea>Medico economic unit, Institut Curie</wicri:orgArea></affiliation></author><author><name sortKey="Sigal Zafrani, B" sort="Sigal Zafrani, B" uniqKey="Sigal Zafrani B" first="B." last="Sigal-Zafrani">B. Sigal-Zafrani</name><affiliation wicri:level="3"><nlm:aff id="aff3">Pathology Department, Institut Curie, Paris</nlm:aff><country>France</country><placeName><settlement type="city">Paris</settlement><region type="région" nuts="2">Île-de-France</region></placeName><wicri:orgArea>Pathology Department, Institut Curie</wicri:orgArea></affiliation></author><author><name sortKey="Fall, M" sort="Fall, M" uniqKey="Fall M" first="M." last="Fall">M. Fall</name><affiliation wicri:level="3"><nlm:aff id="aff2">Medico economic unit, Institut Curie, Paris</nlm:aff><country>France</country><placeName><settlement type="city">Paris</settlement><region type="région" nuts="2">Île-de-France</region></placeName><wicri:orgArea>Medico economic unit, Institut Curie</wicri:orgArea></affiliation></author><author><name sortKey="Rousseau, C" sort="Rousseau, C" uniqKey="Rousseau C" first="C." last="Rousseau">C. Rousseau</name><affiliation><nlm:aff id="aff4">Nuclear medicine Department, Institut de Cancérologie de l'Ouest-Center Gauducheau, Nantes</nlm:aff><wicri:noCountry code="subfield">Nantes</wicri:noCountry></affiliation></author><author><name sortKey="Alran, S" sort="Alran, S" uniqKey="Alran S" first="S." last="Alran">S. Alran</name><affiliation wicri:level="3"><nlm:aff id="aff5">Surgical Department, Institut Curie, Paris</nlm:aff><country>France</country><placeName><settlement type="city">Paris</settlement><region type="région" nuts="2">Île-de-France</region></placeName><wicri:orgArea>Surgical Department, Institut Curie</wicri:orgArea></affiliation></author><author><name sortKey="Rouanet, P" sort="Rouanet, P" uniqKey="Rouanet P" first="P." last="Rouanet">P. Rouanet</name><affiliation><nlm:aff id="aff6">Surgical Department, Center Val d'Aurel Montpellier</nlm:aff><wicri:noCountry code="subfield">Center Val d'Aurel Montpellier</wicri:noCountry></affiliation></author><author><name sortKey="Belichard, C" sort="Belichard, C" uniqKey="Belichard C" first="C." last="Belichard">C. Belichard</name><affiliation><nlm:aff id="aff7">Surgical Department, Center René Huguenin, Saint Cloud</nlm:aff><wicri:noCountry code="subfield">Saint Cloud</wicri:noCountry></affiliation></author><author><name sortKey="Mignotte, H" sort="Mignotte, H" uniqKey="Mignotte H" first="H." last="Mignotte">H. Mignotte</name><affiliation wicri:level="3"><nlm:aff id="aff8">Surgical Department, Center Léon Bérard, Lyon</nlm:aff><country>France</country><placeName><settlement type="city">Lyon</settlement><region type="region" nuts="2">Auvergne-Rhône-Alpes</region><region type="old region" nuts="2">Rhône-Alpes</region></placeName><wicri:orgArea>Surgical Department, Center Léon Bérard</wicri:orgArea></affiliation></author><author><name sortKey="Ferron, G" sort="Ferron, G" uniqKey="Ferron G" first="G." last="Ferron">G. Ferron</name><affiliation wicri:level="3"><nlm:aff id="aff9">Surgical Department, Institut Claudius Regaud, Toulouse</nlm:aff><country>France</country><placeName><settlement type="city">Toulouse</settlement><region type="region" nuts="2">Occitanie (région administrative)</region><region type="old region" nuts="2">Midi-Pyrénées</region></placeName><wicri:orgArea>Surgical Department, Institut Claudius Regaud</wicri:orgArea></affiliation></author><author><name sortKey="Marchal, F" sort="Marchal, F" uniqKey="Marchal F" first="F." last="Marchal">F. Marchal</name><affiliation wicri:level="3"><nlm:aff id="aff10">Surgical Department, Center Alexis Vautrin, Nancy</nlm:aff><country>France</country><placeName><settlement type="city">Nancy</settlement><region type="region" nuts="2">Grand Est</region><region type="old region" nuts="2">Lorraine (région)</region></placeName><wicri:orgArea>Surgical Department, Center Alexis Vautrin</wicri:orgArea></affiliation></author><author><name sortKey="Giard, S" sort="Giard, S" uniqKey="Giard S" first="S." last="Giard">S. Giard</name><affiliation><nlm:aff id="aff11">Surgical Department, Center Oscar Lambret, Lille</nlm:aff><wicri:noCountry code="subfield">Lille</wicri:noCountry></affiliation></author><author><name sortKey="Tunon De Lara, C" sort="Tunon De Lara, C" uniqKey="Tunon De Lara C" first="C." last="Tunon De Lara">C. Tunon De Lara</name><affiliation><nlm:aff id="aff12">Surgical Department, Center Bergonié, Bordeaux</nlm:aff><wicri:noCountry code="subfield">Bordeaux</wicri:noCountry></affiliation></author><author><name sortKey="Le Bouedec, G" sort="Le Bouedec, G" uniqKey="Le Bouedec G" first="G." last="Le Bouedec">G. Le Bouedec</name><affiliation><nlm:aff id="aff13">Surgical Department, Center Jean Perrin, Clermont Ferrand</nlm:aff><wicri:noCountry code="subfield">Clermont Ferrand</wicri:noCountry></affiliation></author><author><name sortKey="Cuisenier, J" sort="Cuisenier, J" uniqKey="Cuisenier J" first="J." last="Cuisenier">J. Cuisenier</name><affiliation><nlm:aff id="aff14">Surgical Department, Center Georges François Leclerc, Dijon</nlm:aff><wicri:noCountry code="subfield">Dijon</wicri:noCountry></affiliation></author><author><name sortKey="Werner, R" sort="Werner, R" uniqKey="Werner R" first="R." last="Werner">R. Werner</name><affiliation><nlm:aff id="aff15">Surgical Department, Center Jean Godinot, Reims</nlm:aff><wicri:noCountry code="subfield">Reims</wicri:noCountry></affiliation></author><author><name sortKey="Raoust, I" sort="Raoust, I" uniqKey="Raoust I" first="I." last="Raoust">I. Raoust</name><affiliation><nlm:aff id="aff16">Surgical Department, Center Georges Lacassagne, Nice</nlm:aff><wicri:noCountry code="subfield">Nice</wicri:noCountry></affiliation></author><author><name sortKey="Rodier, J F" sort="Rodier, J F" uniqKey="Rodier J" first="J.-F." last="Rodier">J.-F. Rodier</name><affiliation wicri:level="3"><nlm:aff id="aff17">Surgical Department, Center Paul Strauss, Strasbourg</nlm:aff><country>France</country><placeName><settlement type="city">Strasbourg</settlement><region type="region" nuts="2">Grand Est</region><region type="old region" nuts="2">Alsace (région administrative)</region></placeName><wicri:orgArea>Surgical Department, Center Paul Strauss</wicri:orgArea></affiliation></author><author><name sortKey="Laki, F" sort="Laki, F" uniqKey="Laki F" first="F." last="Laki">F. Laki</name><affiliation wicri:level="3"><nlm:aff id="aff2">Medico economic unit, Institut Curie, Paris</nlm:aff><country>France</country><placeName><settlement type="city">Paris</settlement><region type="région" nuts="2">Île-de-France</region></placeName><wicri:orgArea>Medico economic unit, Institut Curie</wicri:orgArea></affiliation><affiliation wicri:level="3"><nlm:aff id="aff5">Surgical Department, Institut Curie, Paris</nlm:aff><country>France</country><placeName><settlement type="city">Paris</settlement><region type="région" nuts="2">Île-de-France</region></placeName><wicri:orgArea>Surgical Department, Institut Curie</wicri:orgArea></affiliation></author><author><name sortKey="Colombo, P E" sort="Colombo, P E" uniqKey="Colombo P" first="P.-E." last="Colombo">P.-E. Colombo</name><affiliation><nlm:aff id="aff6">Surgical Department, Center Val d'Aurel Montpellier</nlm:aff><wicri:noCountry code="subfield">Center Val d'Aurel Montpellier</wicri:noCountry></affiliation></author><author><name sortKey="Lasry, S" sort="Lasry, S" uniqKey="Lasry S" first="S." last="Lasry">S. Lasry</name><affiliation><nlm:aff id="aff7">Surgical Department, Center René Huguenin, Saint Cloud</nlm:aff><wicri:noCountry code="subfield">Saint Cloud</wicri:noCountry></affiliation></author><author><name sortKey="Faure, C" sort="Faure, C" uniqKey="Faure C" first="C." last="Faure">C. Faure</name><affiliation wicri:level="3"><nlm:aff id="aff8">Surgical Department, Center Léon Bérard, Lyon</nlm:aff><country>France</country><placeName><settlement type="city">Lyon</settlement><region type="region" nuts="2">Auvergne-Rhône-Alpes</region><region type="old region" nuts="2">Rhône-Alpes</region></placeName><wicri:orgArea>Surgical Department, Center Léon Bérard</wicri:orgArea></affiliation></author><author><name sortKey="Charitansky, H" sort="Charitansky, H" uniqKey="Charitansky H" first="H." last="Charitansky">H. Charitansky</name><affiliation wicri:level="3"><nlm:aff id="aff9">Surgical Department, Institut Claudius Regaud, Toulouse</nlm:aff><country>France</country><placeName><settlement type="city">Toulouse</settlement><region type="region" nuts="2">Occitanie (région administrative)</region><region type="old region" nuts="2">Midi-Pyrénées</region></placeName><wicri:orgArea>Surgical Department, Institut Claudius Regaud</wicri:orgArea></affiliation></author><author><name sortKey="Olivier, J B" sort="Olivier, J B" uniqKey="Olivier J" first="J.-B." last="Olivier">J.-B. Olivier</name><affiliation wicri:level="3"><nlm:aff id="aff10">Surgical Department, Center Alexis Vautrin, Nancy</nlm:aff><country>France</country><placeName><settlement type="city">Nancy</settlement><region type="region" nuts="2">Grand Est</region><region type="old region" nuts="2">Lorraine (région)</region></placeName><wicri:orgArea>Surgical Department, Center Alexis Vautrin</wicri:orgArea></affiliation></author><author><name sortKey="Chauvet, M P" sort="Chauvet, M P" uniqKey="Chauvet M" first="M.-P." last="Chauvet">M.-P. Chauvet</name><affiliation><nlm:aff id="aff11">Surgical Department, Center Oscar Lambret, Lille</nlm:aff><wicri:noCountry code="subfield">Lille</wicri:noCountry></affiliation></author><author><name sortKey="Bussieres, E" sort="Bussieres, E" uniqKey="Bussieres E" first="E." last="Bussières">E. Bussières</name><affiliation><nlm:aff id="aff12">Surgical Department, Center Bergonié, Bordeaux</nlm:aff><wicri:noCountry code="subfield">Bordeaux</wicri:noCountry></affiliation></author><author><name sortKey="Gimbergues, P" sort="Gimbergues, P" uniqKey="Gimbergues P" first="P." last="Gimbergues">P. Gimbergues</name><affiliation><nlm:aff id="aff13">Surgical Department, Center Jean Perrin, Clermont Ferrand</nlm:aff><wicri:noCountry code="subfield">Clermont Ferrand</wicri:noCountry></affiliation></author><author><name sortKey="Flipo, B" sort="Flipo, B" uniqKey="Flipo B" first="B." last="Flipo">B. Flipo</name><affiliation><nlm:aff id="aff16">Surgical Department, Center Georges Lacassagne, Nice</nlm:aff><wicri:noCountry code="subfield">Nice</wicri:noCountry></affiliation></author><author><name sortKey="Houvenaeghel, G" sort="Houvenaeghel, G" uniqKey="Houvenaeghel G" first="G." last="Houvenaeghel">G. Houvenaeghel</name><affiliation wicri:level="1"><nlm:aff id="aff18">Surgical Department, Institut Paoli Calmette Marseille, France</nlm:aff><country xml:lang="fr">France</country><wicri:regionArea>Surgical Department, Institut Paoli Calmette Marseille</wicri:regionArea><wicri:noRegion>Institut Paoli Calmette Marseille</wicri:noRegion><wicri:noRegion>Institut Paoli Calmette Marseille</wicri:noRegion></affiliation></author><author><name sortKey="Dravet, F" sort="Dravet, F" uniqKey="Dravet F" first="F." last="Dravet">F. Dravet</name><affiliation><nlm:aff id="aff1">Surgical Department, Institut de Cancérologie de l'Ouest-Center Gauducheau, Nantes</nlm:aff><wicri:noCountry code="subfield">Nantes</wicri:noCountry></affiliation></author><author><name sortKey="Livartowski, A" sort="Livartowski, A" uniqKey="Livartowski A" first="A." last="Livartowski">A. Livartowski</name><affiliation wicri:level="3"><nlm:aff id="aff2">Medico economic unit, Institut Curie, Paris</nlm:aff><country>France</country><placeName><settlement type="city">Paris</settlement><region type="région" nuts="2">Île-de-France</region></placeName><wicri:orgArea>Medico economic unit, Institut Curie</wicri:orgArea></affiliation></author></analytic><series><title level="j">Annals of Oncology</title><idno type="ISSN">0923-7534</idno><idno type="eISSN">1569-8041</idno><imprint><date when="2011">2011</date></imprint></series></biblStruct></sourceDesc></fileDesc><profileDesc><textClass></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en"><sec><title>Background:</title><p>Our objective was to assess the global cost of the sentinel lymph node detection [axillary sentinel lymph node detection (ASLND)] compared with standard axillary lymphadenectomy [axillary lymph node dissection (ALND)] for early breast cancer patients.</p></sec><sec><title>Patients and methods:</title><p>We conducted a prospective, multi-institutional, observational, cost comparative analysis. Cost calculations were realized with the micro-costing method from the diagnosis until 1 month after the last surgery.</p></sec><sec><title>Results:</title><p>Eight hundred and thirty nine patients were included in the ASLND group and 146 in the ALND group. The cost generated for a patient with an ASLND, with one preoperative scintigraphy, a combined method for sentinel node detection, an intraoperative pathological analysis without lymphadenectomy, was lower than the cost generated for a patient with lymphadenectomy [€2947 (σ = 580) versus €3331 (σ = 902); <italic>P</italic> = 0.0001].</p></sec><sec><title>Conclusion:</title><p>ASLND, involving expensive techniques, was finally less expensive than ALND. The length of hospital stay was the cost driver of these procedures. The current observational study points the heterogeneous practices for this validated and largely diffused technique. Several technical choices have an impact on the cost of ASLND, as intraoperative analysis allowing to reduce rehospitalization rate for secondary lymphadenectomy or preoperative scintigraphy, suggesting possible savings on hospital resources.</p></sec></div></front></TEI><affiliations><list><country><li>France</li></country><region><li>Alsace (région administrative)</li><li>Auvergne-Rhône-Alpes</li><li>Grand Est</li><li>Lorraine (région)</li><li>Midi-Pyrénées</li><li>Occitanie (région administrative)</li><li>Rhône-Alpes</li><li>Île-de-France</li></region><settlement><li>Lyon</li><li>Nancy</li><li>Paris</li><li>Strasbourg</li><li>Toulouse</li></settlement></list><tree><noCountry><name sortKey="Belichard, C" sort="Belichard, C" uniqKey="Belichard C" first="C." last="Belichard">C. Belichard</name><name sortKey="Bussieres, E" sort="Bussieres, E" uniqKey="Bussieres E" first="E." last="Bussières">E. Bussières</name><name sortKey="Chauvet, M P" sort="Chauvet, M P" uniqKey="Chauvet M" first="M.-P." last="Chauvet">M.-P. Chauvet</name><name sortKey="Classe, J M" sort="Classe, J M" uniqKey="Classe J" first="J. M." last="Classe">J. M. Classe</name><name sortKey="Colombo, P E" sort="Colombo, P E" uniqKey="Colombo P" first="P.-E." last="Colombo">P.-E. Colombo</name><name sortKey="Cuisenier, J" sort="Cuisenier, J" uniqKey="Cuisenier J" first="J." last="Cuisenier">J. Cuisenier</name><name sortKey="Dravet, F" sort="Dravet, F" uniqKey="Dravet F" first="F." last="Dravet">F. Dravet</name><name sortKey="Flipo, B" sort="Flipo, B" uniqKey="Flipo B" first="B." last="Flipo">B. Flipo</name><name sortKey="Giard, S" sort="Giard, S" uniqKey="Giard S" first="S." last="Giard">S. Giard</name><name sortKey="Gimbergues, P" sort="Gimbergues, P" uniqKey="Gimbergues P" first="P." last="Gimbergues">P. Gimbergues</name><name sortKey="Lasry, S" sort="Lasry, S" uniqKey="Lasry S" first="S." last="Lasry">S. Lasry</name><name sortKey="Le Bouedec, G" sort="Le Bouedec, G" uniqKey="Le Bouedec G" first="G." last="Le Bouedec">G. Le Bouedec</name><name sortKey="Raoust, I" sort="Raoust, I" uniqKey="Raoust I" first="I." last="Raoust">I. Raoust</name><name sortKey="Rouanet, P" sort="Rouanet, P" uniqKey="Rouanet P" first="P." last="Rouanet">P. Rouanet</name><name sortKey="Rousseau, C" sort="Rousseau, C" uniqKey="Rousseau C" first="C." last="Rousseau">C. Rousseau</name><name sortKey="Tunon De Lara, C" sort="Tunon De Lara, C" uniqKey="Tunon De Lara C" first="C." last="Tunon De Lara">C. Tunon De Lara</name><name sortKey="Werner, R" sort="Werner, R" uniqKey="Werner R" first="R." last="Werner">R. Werner</name></noCountry><country name="France"><region name="Île-de-France"><name sortKey="Baffert, S" sort="Baffert, S" uniqKey="Baffert S" first="S." last="Baffert">S. Baffert</name></region><name sortKey="Alran, S" sort="Alran, S" uniqKey="Alran S" first="S." last="Alran">S. Alran</name><name sortKey="Charitansky, H" sort="Charitansky, H" uniqKey="Charitansky H" first="H." last="Charitansky">H. Charitansky</name><name sortKey="Fall, M" sort="Fall, M" uniqKey="Fall M" first="M." last="Fall">M. Fall</name><name sortKey="Faure, C" sort="Faure, C" uniqKey="Faure C" first="C." last="Faure">C. Faure</name><name sortKey="Ferron, G" sort="Ferron, G" uniqKey="Ferron G" first="G." last="Ferron">G. Ferron</name><name sortKey="Houvenaeghel, G" sort="Houvenaeghel, G" uniqKey="Houvenaeghel G" first="G." last="Houvenaeghel">G. Houvenaeghel</name><name sortKey="Laki, F" sort="Laki, F" uniqKey="Laki F" first="F." last="Laki">F. Laki</name><name sortKey="Laki, F" sort="Laki, F" uniqKey="Laki F" first="F." last="Laki">F. Laki</name><name sortKey="Livartowski, A" sort="Livartowski, A" uniqKey="Livartowski A" first="A." last="Livartowski">A. Livartowski</name><name sortKey="Marchal, F" sort="Marchal, F" uniqKey="Marchal F" first="F." last="Marchal">F. Marchal</name><name sortKey="Mignotte, H" sort="Mignotte, H" uniqKey="Mignotte H" first="H." last="Mignotte">H. Mignotte</name><name sortKey="Olivier, J B" sort="Olivier, J B" uniqKey="Olivier J" first="J.-B." last="Olivier">J.-B. Olivier</name><name sortKey="Rodier, J F" sort="Rodier, J F" uniqKey="Rodier J" first="J.-F." last="Rodier">J.-F. Rodier</name><name sortKey="Sigal Zafrani, B" sort="Sigal Zafrani, B" uniqKey="Sigal Zafrani B" first="B." last="Sigal-Zafrani">B. Sigal-Zafrani</name></country></tree></affiliations></record>Pour manipuler ce document sous Unix (Dilib)
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