Training for sentinel lymph node surgery successful
MedWire News: The training methods used for surgeons participating in the National Surgical Adjuvant Breast and Bowel Project (NSABP) B-32 trial resulted in uniform and high overall sentinel lymph node (SLN) resection rates.
The NSABP B-32 trial was designed to determine whether SLN resection can achieve the same therapeutic outcomes as axillary lymph node resection but with fewer side effects, explain David Krag (University of Vermont, Beaumont, USA) and colleagues.
Training for the trial included a protocol manual, a site visit with key participants, and an intra-operative session with the surgeon. The surgeons were divided into three categories; core-trained, site-trained and expedited-trained which comprised of surgeons with extensive prior experience of the technique.
To assess the effectiveness of the training methods, overall protocol compliance, and their relationship to technical outcomes, Krag and team audited 224 participating surgeons for procedural compliance, operative note, pathology report, and data entry.
The researchers report that the overall SLN resection success rate was 96.9% for the 4994 patients recruited to the study, and there were no significant differences between the three training groups.
Among all surgeons, a significant positive association was observed between the average number of procedural errors and the false-negative rate, which was 9.5%.
Audit outcomes were excellent in all four categories for all training groups. “Procedural, operative note, and pathology report errors averaged well below one error per patient, while data entry errors averaged between one and two errors per patient,” observe Krag et al.
Of note, subgroup analyses identified some variation in false-negative rates that were related to audited outcome performance measures, indicating the value of similar auditing measures on future trials, note the researchers.
The results show that “the B-32 training program allowed surgeons from the three trained groups to achieve an overall equal and high success rate throughout the trial,” conclude Krag and co-authors in the Journal of the National Cancer Institute.
They add: “Surgeons were no longer audited after successful completion of two audits, and the sustained high SLN resection rates indicate that compliance did not materially decrease after the audit period.”
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By Laura Dean