{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,23]],"date-time":"2026-08-23T15:32:48Z","timestamp":1787499168144,"version":"build-2736575974"},"reference-count":39,"publisher":"Wiley","issue":"3","license":[{"start":{"date-parts":[[2025,1,28]],"date-time":"2025-01-28T00:00:00Z","timestamp":1738022400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["ANZ Journal of Surgery"],"published-print":{"date-parts":[[2025,3]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>The clinical management of the axilla in early breast cancer has changed since the Z0011 trial, which showed that axillary lymph node dissection (ALND) is not necessary in select patients with a positive sentinel lymph node biopsy (SLNB). Studies have shown a significant decrease in the rates of completion ALND (cALND) since Z0011. The aims of this study were to investigate the effect of the Z0011 trial on the management of positive axillary sentinel nodes and the trends in axillary surgical management since 2005 in Australia and New Zealand.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This study utilized prospectively maintained data from the BreastSurgANZ Quality Audit (BQA). Patients with early breast cancer between 2005 and 2023 satisfying the Z0011 trial inclusion criteria undergoing SLNB or SLNB followed by cALND were identified.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      There were 91\u2009196 patients who underwent breast\u2010conserving surgery and SLNB of which 12\u2009035 were node positive therefore satisfying the Z0011 trial inclusion criteria, of which 8194 (68.1%) received SLNB only with no cALND. There has been a 55.4% reduction in the rate of cALND after 2010 when the Z0011 trial was published (\n                      <jats:italic>P<\/jats:italic>\n                      \u2009&lt;\u20090.001). There was a significant downward trend in the number of cALND performed per year (\n                      <jats:italic>R<\/jats:italic>\n                      <jats:sup>2<\/jats:sup>\n                      \u2009=\u20090.890,\n                      <jats:italic>P<\/jats:italic>\n                      \u2009&lt;\u20090.001).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>The Z0011 trial was a practice changing trial and since its publication in 2010 has been correlated with de\u2010escalation in surgical management of the axilla and decline in the rates of cALND in Australia and New Zealand.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/ans.19404","type":"journal-article","created":{"date-parts":[[2025,1,29]],"date-time":"2025-01-29T02:35:26Z","timestamp":1738118126000},"page":"503-511","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["Clinical impact of the\n                    <scp>Z0011<\/scp>\n                    trial on axillary surgical management in Australia and New Zealand from the\n                    <scp>BreastSurgANZ<\/scp>\n                    Quality Audit"],"prefix":"10.1111","volume":"95","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-3793-2069","authenticated-orcid":false,"given":"Christine","family":"Zhao","sequence":"first","affiliation":[{"name":"Royal Prince Alfred Hospital Sydney Local Health District  Sydney Australia"},{"name":"School of Medicine The University of Sydney  Sydney Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nina","family":"Sriram","sequence":"additional","affiliation":[{"name":"General Surgery Blacktown and Mount Druitt Hospitals  Sydney New South Wales Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kerry","family":"Hitos","sequence":"additional","affiliation":[{"name":"School of Medicine The University of Sydney  Sydney Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"T Michael","family":"Hughes","sequence":"additional","affiliation":[{"name":"School of Medicine and Psychology The Australian National University  Canberra Australia"},{"name":"General Surgery Sydney Adventist Hospital  Sydney New South Wales Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9674-4404","authenticated-orcid":false,"given":"Nicholas","family":"Ngui","sequence":"additional","affiliation":[{"name":"General Surgery Blacktown and Mount Druitt Hospitals  Sydney New South Wales Australia"},{"name":"School of Medicine and Psychology The Australian National University  Canberra Australia"},{"name":"General Surgery Sydney Adventist Hospital  Sydney New South Wales Australia"},{"name":"School of Medicine Western Sydney University  Sydney New South Wales Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2025,1,28]]},"reference":[{"key":"e_1_2_7_2_1","doi-asserted-by":"publisher","DOI":"10.1111\/tbj.14191"},{"key":"e_1_2_7_3_1","doi-asserted-by":"publisher","DOI":"10.1093\/jnci\/djj158"},{"key":"e_1_2_7_4_1","doi-asserted-by":"publisher","DOI":"10.1002\/1097-0142(20010915)92:6<1368::AID-CNCR1459>3.0.CO;2-9"},{"key":"e_1_2_7_5_1","doi-asserted-by":"publisher","DOI":"10.1245\/s10434-020-08923-7"},{"key":"e_1_2_7_6_1","doi-asserted-by":"publisher","DOI":"10.1245\/s10434-016-5669-2"},{"key":"e_1_2_7_7_1","doi-asserted-by":"publisher","DOI":"10.1097\/SLA.0b013e3181f08f32"},{"key":"e_1_2_7_8_1","doi-asserted-by":"publisher","DOI":"10.1245\/ASO.2004.12.911"},{"key":"e_1_2_7_9_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa012782"},{"key":"e_1_2_7_10_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.breast.2022.02.014"},{"key":"e_1_2_7_11_1","doi-asserted-by":"publisher","DOI":"10.1007\/s10549-019-05157-4"},{"key":"e_1_2_7_12_1","doi-asserted-by":"publisher","DOI":"10.14216\/kjco.20004"},{"key":"e_1_2_7_13_1","doi-asserted-by":"publisher","DOI":"10.1097\/SLA.0000000000002354"},{"key":"e_1_2_7_14_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12957-022-02673-4"},{"key":"e_1_2_7_15_1","doi-asserted-by":"publisher","DOI":"10.1097\/SLA.0000000000002440"},{"key":"e_1_2_7_16_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jamcollsurg.2015.02.035"},{"key":"e_1_2_7_17_1","doi-asserted-by":"publisher","DOI":"10.1007\/s40258-022-00771-8"},{"key":"e_1_2_7_18_1","volume-title":"IBM SPSS Statistics for Macintosh. 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