The Z0011 trial by the American College of Surgeons Oncology Group compared outcomes of different methods of axillary surgery (removal of lymph nodes in the armpit to check for cancer spread). The results published in 2010 showed that whether women with early breast cancer had sentinel lymph node biopsy (removal of the first lymph node which cancer is likely spread to) or axillary clearance (removal of most lymph nodes in the armpit), no difference was seen in whether the cancer then came back. As sentinel node biopsy has less side effects, many countries have changed which axillary surgery is used, based on the Z0011 research.
The BreastSurgANZ Quality Audit data was used to investigate changes in axillary surgery in Australia and Aotearoa New Zealand after the publication of the Z0011 study. This investigation identified that each year between 2010 and 2023 there was a decrease in the use of axillary clearance surgery, resulting in a 55% reduction of axillary clearances. This indicates that the Z0011 study changed how breast cancer is treated in Australia and Aotearoa New Zealand, improving patient care and reducing potential side effects of axillary clearance
Reference:
Zhao, C., Sriram, N., Hitos, K., Hughes, T.M. and Ngui, N. (2025), Clinical impact of the Z0011 trial on axillary surgical management in Australia and New Zealand from the BreastSurgANZ Quality Audit. ANZ Journal of Surgery, 95: 503-511. https://doi.org/10.1111/ans.19404