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 : 002C15 ( Pmc/Curation ); précédent : 002C14; suivant : 002C16Cost 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
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J. M. Classe<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>
<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>
<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>
<affiliation><nlm:aff id="aff7">Surgical Department, Center René Huguenin, Saint Cloud</nlm:aff>
<wicri:noCountry code="subfield">Saint Cloud</wicri:noCountry>
</affiliation>
<affiliation><nlm:aff id="aff11">Surgical Department, Center Oscar Lambret, Lille</nlm:aff>
<wicri:noCountry code="subfield">Lille</wicri:noCountry>
</affiliation>
<affiliation><nlm:aff id="aff12">Surgical Department, Center Bergonié, Bordeaux</nlm:aff>
<wicri:noCountry code="subfield">Bordeaux</wicri:noCountry>
</affiliation>
<affiliation><nlm:aff id="aff13">Surgical Department, Center Jean Perrin, Clermont Ferrand</nlm:aff>
<wicri:noCountry code="subfield">Clermont Ferrand</wicri:noCountry>
</affiliation>
<affiliation><nlm:aff id="aff14">Surgical Department, Center Georges François Leclerc, Dijon</nlm:aff>
<wicri:noCountry code="subfield">Dijon</wicri:noCountry>
</affiliation>
<affiliation><nlm:aff id="aff15">Surgical Department, Center Jean Godinot, Reims</nlm:aff>
<wicri:noCountry code="subfield">Reims</wicri:noCountry>
</affiliation>
<affiliation><nlm:aff id="aff16">Surgical Department, Center Georges Lacassagne, Nice</nlm:aff>
<wicri:noCountry code="subfield">Nice</wicri:noCountry>
</affiliation>
<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>
<affiliation><nlm:aff id="aff7">Surgical Department, Center René Huguenin, Saint Cloud</nlm:aff>
<wicri:noCountry code="subfield">Saint Cloud</wicri:noCountry>
</affiliation>
<affiliation><nlm:aff id="aff11">Surgical Department, Center Oscar Lambret, Lille</nlm:aff>
<wicri:noCountry code="subfield">Lille</wicri:noCountry>
</affiliation>
<affiliation><nlm:aff id="aff12">Surgical Department, Center Bergonié, Bordeaux</nlm:aff>
<wicri:noCountry code="subfield">Bordeaux</wicri:noCountry>
</affiliation>
<affiliation><nlm:aff id="aff13">Surgical Department, Center Jean Perrin, Clermont Ferrand</nlm:aff>
<wicri:noCountry code="subfield">Clermont Ferrand</wicri:noCountry>
</affiliation>
<affiliation><nlm:aff id="aff16">Surgical Department, Center Georges Lacassagne, Nice</nlm:aff>
<wicri:noCountry code="subfield">Nice</wicri:noCountry>
</affiliation>
<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>
Le document en format XML
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<author><name sortKey="Fall, M" sort="Fall, M" uniqKey="Fall M" first="M." last="Fall">M. Fall</name>
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<author><name sortKey="Rouanet, P" sort="Rouanet, P" uniqKey="Rouanet P" first="P." last="Rouanet">P. Rouanet</name>
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</affiliation>
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<author><name sortKey="Belichard, C" sort="Belichard, C" uniqKey="Belichard C" first="C." last="Belichard">C. Belichard</name>
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<wicri:noCountry code="subfield">Saint Cloud</wicri:noCountry>
</affiliation>
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<author><name sortKey="Mignotte, H" sort="Mignotte, H" uniqKey="Mignotte H" first="H." last="Mignotte">H. Mignotte</name>
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</placeName>
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</affiliation>
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<author><name sortKey="Ferron, G" sort="Ferron, G" uniqKey="Ferron G" first="G." last="Ferron">G. Ferron</name>
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<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>
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<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>
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<author><name sortKey="Giard, S" sort="Giard, S" uniqKey="Giard S" first="S." last="Giard">S. Giard</name>
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<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>
</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>
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<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>
</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>
<pmc article-type="research-article"><pmc-comment>The publisher of this article does not allow downloading of the full text in XML form.</pmc-comment>
<front><journal-meta><journal-id journal-id-type="nlm-ta">Ann Oncol</journal-id>
<journal-id journal-id-type="iso-abbrev">Ann. Oncol</journal-id>
<journal-id journal-id-type="hwp">annonc</journal-id>
<journal-id journal-id-type="publisher-id">annonc</journal-id>
<journal-title-group><journal-title>Annals of Oncology</journal-title>
</journal-title-group>
<issn pub-type="ppub">0923-7534</issn>
<issn pub-type="epub">1569-8041</issn>
<publisher><publisher-name>Oxford University Press</publisher-name>
</publisher>
</journal-meta>
<article-meta><article-id pub-id-type="pmid">21896543</article-id>
<article-id pub-id-type="pmc">3335244</article-id>
<article-id pub-id-type="doi">10.1093/annonc/mdr355</article-id>
<article-categories><subj-group subj-group-type="heading"><subject>Original Articles</subject>
<subj-group><subject>Breast Cancer</subject>
</subj-group>
</subj-group>
</article-categories>
<title-group><article-title>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’</article-title>
</title-group>
<contrib-group><contrib contrib-type="author"><name><surname>Classe</surname>
<given-names>J. M.</given-names>
</name>
<xref ref-type="aff" rid="aff1">1</xref>
<xref ref-type="corresp" rid="cor1">*</xref>
</contrib>
<contrib contrib-type="author"><name><surname>Baffert</surname>
<given-names>S.</given-names>
</name>
<xref ref-type="aff" rid="aff2">2</xref>
</contrib>
<contrib contrib-type="author"><name><surname>Sigal-Zafrani</surname>
<given-names>B.</given-names>
</name>
<xref ref-type="aff" rid="aff3">3</xref>
</contrib>
<contrib contrib-type="author"><name><surname>Fall</surname>
<given-names>M.</given-names>
</name>
<xref ref-type="aff" rid="aff2">2</xref>
</contrib>
<contrib contrib-type="author"><name><surname>Rousseau</surname>
<given-names>C.</given-names>
</name>
<xref ref-type="aff" rid="aff4">4</xref>
</contrib>
<contrib contrib-type="author"><name><surname>Alran</surname>
<given-names>S.</given-names>
</name>
<xref ref-type="aff" rid="aff5">5</xref>
</contrib>
<contrib contrib-type="author"><name><surname>Rouanet</surname>
<given-names>P.</given-names>
</name>
<xref ref-type="aff" rid="aff6">6</xref>
</contrib>
<contrib contrib-type="author"><name><surname>Belichard</surname>
<given-names>C.</given-names>
</name>
<xref ref-type="aff" rid="aff7">7</xref>
</contrib>
<contrib contrib-type="author"><name><surname>Mignotte</surname>
<given-names>H.</given-names>
</name>
<xref ref-type="aff" rid="aff8">8</xref>
</contrib>
<contrib contrib-type="author"><name><surname>Ferron</surname>
<given-names>G.</given-names>
</name>
<xref ref-type="aff" rid="aff9">9</xref>
</contrib>
<contrib contrib-type="author"><name><surname>Marchal</surname>
<given-names>F.</given-names>
</name>
<xref ref-type="aff" rid="aff10">10</xref>
</contrib>
<contrib contrib-type="author"><name><surname>Giard</surname>
<given-names>S.</given-names>
</name>
<xref ref-type="aff" rid="aff11">11</xref>
</contrib>
<contrib contrib-type="author"><name><surname>Tunon de Lara</surname>
<given-names>C.</given-names>
</name>
<xref ref-type="aff" rid="aff12">12</xref>
</contrib>
<contrib contrib-type="author"><name><surname>Le Bouedec</surname>
<given-names>G.</given-names>
</name>
<xref ref-type="aff" rid="aff13">13</xref>
</contrib>
<contrib contrib-type="author"><name><surname>Cuisenier</surname>
<given-names>J.</given-names>
</name>
<xref ref-type="aff" rid="aff14">14</xref>
</contrib>
<contrib contrib-type="author"><name><surname>Werner</surname>
<given-names>R.</given-names>
</name>
<xref ref-type="aff" rid="aff15">15</xref>
</contrib>
<contrib contrib-type="author"><name><surname>Raoust</surname>
<given-names>I.</given-names>
</name>
<xref ref-type="aff" rid="aff16">16</xref>
</contrib>
<contrib contrib-type="author"><name><surname>Rodier</surname>
<given-names>J.-F.</given-names>
</name>
<xref ref-type="aff" rid="aff17">17</xref>
</contrib>
<contrib contrib-type="author"><name><surname>Laki</surname>
<given-names>F.</given-names>
</name>
<xref ref-type="aff" rid="aff2">2</xref>
<xref ref-type="aff" rid="aff5">5</xref>
</contrib>
<contrib contrib-type="author"><name><surname>Colombo</surname>
<given-names>P.-E.</given-names>
</name>
<xref ref-type="aff" rid="aff6">6</xref>
</contrib>
<contrib contrib-type="author"><name><surname>Lasry</surname>
<given-names>S.</given-names>
</name>
<xref ref-type="aff" rid="aff7">7</xref>
</contrib>
<contrib contrib-type="author"><name><surname>Faure</surname>
<given-names>C.</given-names>
</name>
<xref ref-type="aff" rid="aff8">8</xref>
</contrib>
<contrib contrib-type="author"><name><surname>Charitansky</surname>
<given-names>H.</given-names>
</name>
<xref ref-type="aff" rid="aff9">9</xref>
</contrib>
<contrib contrib-type="author"><name><surname>Olivier</surname>
<given-names>J.-B.</given-names>
</name>
<xref ref-type="aff" rid="aff10">10</xref>
</contrib>
<contrib contrib-type="author"><name><surname>Chauvet</surname>
<given-names>M.-P.</given-names>
</name>
<xref ref-type="aff" rid="aff11">11</xref>
</contrib>
<contrib contrib-type="author"><name><surname>Bussières</surname>
<given-names>E.</given-names>
</name>
<xref ref-type="aff" rid="aff12">12</xref>
</contrib>
<contrib contrib-type="author"><name><surname>Gimbergues</surname>
<given-names>P.</given-names>
</name>
<xref ref-type="aff" rid="aff13">13</xref>
</contrib>
<contrib contrib-type="author"><name><surname>Flipo</surname>
<given-names>B.</given-names>
</name>
<xref ref-type="aff" rid="aff16">16</xref>
</contrib>
<contrib contrib-type="author"><name><surname>Houvenaeghel</surname>
<given-names>G.</given-names>
</name>
<xref ref-type="aff" rid="aff18">18</xref>
</contrib>
<contrib contrib-type="author"><name><surname>Dravet</surname>
<given-names>F.</given-names>
</name>
<xref ref-type="aff" rid="aff1">1</xref>
</contrib>
<contrib contrib-type="author"><name><surname>Livartowski</surname>
<given-names>A.</given-names>
</name>
<xref ref-type="aff" rid="aff2">2</xref>
</contrib>
</contrib-group>
<aff id="aff1"><label>1</label>
Surgical Department, Institut de Cancérologie de l'Ouest-Center Gauducheau, Nantes</aff>
<aff id="aff2"><label>2</label>
Medico economic unit, Institut Curie, Paris</aff>
<aff id="aff3"><label>3</label>
Pathology Department, Institut Curie, Paris</aff>
<aff id="aff4"><label>4</label>
Nuclear medicine Department, Institut de Cancérologie de l'Ouest-Center Gauducheau, Nantes</aff>
<aff id="aff5"><label>5</label>
Surgical Department, Institut Curie, Paris</aff>
<aff id="aff6"><label>6</label>
Surgical Department, Center Val d'Aurel Montpellier</aff>
<aff id="aff7"><label>7</label>
Surgical Department, Center René Huguenin, Saint Cloud</aff>
<aff id="aff8"><label>8</label>
Surgical Department, Center Léon Bérard, Lyon</aff>
<aff id="aff9"><label>9</label>
Surgical Department, Institut Claudius Regaud, Toulouse</aff>
<aff id="aff10"><label>10</label>
Surgical Department, Center Alexis Vautrin, Nancy</aff>
<aff id="aff11"><label>11</label>
Surgical Department, Center Oscar Lambret, Lille</aff>
<aff id="aff12"><label>12</label>
Surgical Department, Center Bergonié, Bordeaux</aff>
<aff id="aff13"><label>13</label>
Surgical Department, Center Jean Perrin, Clermont Ferrand</aff>
<aff id="aff14"><label>14</label>
Surgical Department, Center Georges François Leclerc, Dijon</aff>
<aff id="aff15"><label>15</label>
Surgical Department, Center Jean Godinot, Reims</aff>
<aff id="aff16"><label>16</label>
Surgical Department, Center Georges Lacassagne, Nice</aff>
<aff id="aff17"><label>17</label>
Surgical Department, Center Paul Strauss, Strasbourg</aff>
<aff id="aff18"><label>18</label>
Surgical Department, Institut Paoli Calmette Marseille, France</aff>
<author-notes><corresp id="cor1"><label>*</label>
<italic>Correspondence to:</italic>
Dr J. M. Classe, Department of surgery, Institut de Cancérologie de l'Ouest—Center René Gauducheau, Boulevard Jacques Monod, 44805 Nantes Saint Herblain, France. Tel: +33-2-40-67-99-59; Fax: +33-2-40-67-97-59; E-mail: <email>jm-classe@nantes.fnclcc.fr</email>
</corresp>
</author-notes>
<pub-date pub-type="ppub"><month>5</month>
<year>2012</year>
</pub-date>
<pub-date pub-type="epub"><day>06</day>
<month>9</month>
<year>2011</year>
</pub-date>
<volume>23</volume>
<issue>5</issue>
<fpage>1170</fpage>
<lpage>1177</lpage>
<history><date date-type="received"><day>9</day>
<month>3</month>
<year>2011</year>
</date>
<date date-type="rev-recd"><day>11</day>
<month>5</month>
<year>2011</year>
</date>
<date date-type="accepted"><day>20</day>
<month>6</month>
<year>2011</year>
</date>
</history>
<permissions><copyright-statement>© The Author 2011. Published by Oxford University Press on behalf of the European Society for Medical Oncology. All rights reserved. For permissions, please email: journals.permissions@oup.com</copyright-statement>
<copyright-year>2012</copyright-year>
</permissions>
<abstract><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>
</abstract>
<kwd-group><kwd>axillary lymphadenectomy</kwd>
<kwd>breast cancer</kwd>
<kwd>cost</kwd>
<kwd>sentinel lymph node</kwd>
</kwd-group>
<counts><page-count count="8"></page-count>
</counts>
</article-meta>
</front>
</pmc>
</record>
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