Day-case breast cancer axillary surgery

Abstract

96Ann R Coll Surg Engl 2005; 87 B reast cancer is the commonest malignancy in women 1 with 29,000 new cases per year being diagnosed in England and Wales. The aggressive approach with radical surgery has changed over the years to being more conservative.2 Standard treatment for most women, now, is excision of the primary tumour (by wide local excision or mastectomy) with axillary lymphadenectomy. This permits locoregional control, staging and accurate prognostication. Suction drainage of the axilla is standard practice to prevent seroma formation 4 but practice varies about the length of time required for axillary drainage with patients frequently having a hospital stay of 5-8 days. 5A recent randomised trial 6 advocated the suturing of flaps, avoidance of drainage and early discharge with patients having a 3.31 day-stay after undergoing wide local excision and level 2 axillary clearance for breast cancer. This compared to a 4.86 day-stay for patients in the control group who had axillary suction drainage until drain output was less than 50 ml over 24 h (P < 0.05).Day-case axillary lymph node surgery (ALNS) for breast carcinoma has been performed at the University Hospital of North Tees for over 6 years. When patients are seen in the breast clinic, their ability to undergo day-case surgery is assessed by ensuring that there is no significant Results: 165 patients underwent intended day-case axillary surgery (axillary dissection level 1/2; median age, 55 years; range, 39-76 years). Of these, 16 (9.7%) were admitted overnight usually due to over-running of theatre lists (n = 13; 81%). 29 patients (17.6%) underwent axillary dissection alone, the remainder had axillary surgery combined with wide local excision (median number of lymph nodes excised 11; range, 2-18). Complications included symptomatic seroma formation in 37 patients (22%) and wound infection in 16 patients (10%). Conclusions: Day-case axillary surgery can be performed safely with surgical morbidity comparing favourably to published work of 'traditional' axillary drainage following lymphadenectomy.

Prosthetic repair of umbilical hernias in adults with local anesthesia in a day-case setting: a comprehensive report from a specialized hernia center

“…Besides hernia repairs, many other surgical procedures can be achieved on a day-case setting [20][21][22]. The mean discharge time was 122 min in the present series.…”

Laparoscopic gastric banding for morbid obesity: outpatient procedure versus overnight stay

“…As the infrastructure of ambulatory surgery improved, other interventions came to the new day surgery units. New upcoming interventions, among others, are laparoscopic cholecystectomy and Nissen fundoplication, minimally invasive parathyroidectomy, axillary dissection, and laparoscopic adrenalectomy, for which several studies have shown the safety and feasibility [1,4,6,[9][10][11][12][13]. Morbidly obese patients are a distinct patient category with their own surgical and anesthesiologic challenges.…”

Limiting factors for development of ambulatory breast surgery in the French hospital network

“…Teams practicing ambulatory surgery have shown that there are benefits for the patients [7][8][9]. Encouraged by our administration, we were able to perform ambulatory breast surgery in spite of the financial penalty.…”

“…Rather than extend the indications, it seems preferable to us that the French hospital centers concentrate on ambulatory senologic surgery. Conservative senologic surgery can be accomplished in the ambulatory setting [6][7][8]. This is what should be promoted.…”