Ambulatory mastectomy for cancer: Feasible and safe in consenting educated patients in a care network

Abstract

Global policy encourages shorter periods of hospitalization in order to minimizing costs. In oncology, one-day surgery for breast cancer is well admitted for conservative surgery, with good acceptance and satisfaction of patients. Ambulatory mastectomy for cancer is more challenging because of higher morbidity both physical and emotional. Its risk is to be considered as “drive-through” mastectomy if no enhanced clinical pathway is organized. A prospective observational study was conducted between January 2017 and December 2018 at Montpellier Cancer Institute in France in the context of a national project for the development of ambulatory surgery in oncology. Mastectomy for breast cancer was chosen in motivated and selected patients. Enhancement of the ambulatory clinical pathway was supported by a dedicated hospital nurse. Pain management was optimized by a systematic locoregional anaesthesia. Careful evaluation of morbidity and satisfaction surveys were done. Sixty-two patients of median age 60 years were included in the study. They were for the majority in good health status, not lonely, and living at a median distance of 67 kilometres from hospital. The ambulatory rate for mastectomy was of 16.2%. One conversion, due to a snowstorm, occurred. No mortality was reported. Immediate morbidity consisted of 4 hematomas (6.4%). Reoperation was performed in 5 patients (8%), with a median delay of 28 days (1–120), because of hematoma in 4 cases (80%) and seroma once. The majority of patients did not report pain, nausea-vomiting or mental distress once at home and the global satisfaction score was 9.22/10. Ambulatory mastectomy for breast cancer is safe and well-accepted in selected and consenting patients in a care network. Medical considerations should always take precedence over financial ones.