La chirurgie en ambulatoire reste peu développée en France. Cela est encore plus vrai pour la chirurgie sénologique. Entre janvier 2005 et juin 2006, nous avons réalisé une enquête rétrospective pour évaluer les facteurs limitant la progression de ce mode d’hospitalisation. Les principaux facteurs limitants sont le respect du périmètre kilométrique (100 km), la complexité du circuit patient lié à la prise en charge de petites tumeurs du sein (intervenants multiples) et enfin, un élément non médical, la tarification à l’acte, insuffisamment valorisée pour la chirurgie ambulatoire. Le passage a un système anglo-saxon (moins de 24 heures) ou mixte (12 et 24 heures) permettrait d’ouvrir la chirurgie ambulatoire plus facilement aux patients actuellement exclus par le système actuel (secteur ambulatoire ouvert 12 heures). In France, breast surgery in ambulatory procedure is not well-developed. This is more real for oncologic breast surgery. Between January 2005 and June 2006, we have done a retrospective assessment to evaluate the limiting factors of the progression of this mode of hospitalization. The principal limiting factors are the respect of the kilometric perimeter (100 km), the complexity of the patient circuit related to the medical management of small breast tumour (multiple practitioners) and finally a non-medical element which is billing of the surgical act which is not inciting for the ambulatory procedure. The transition to an anglo-saxon system (“one day surgery”: less than 24 hours) or mixed system (less than 12 hours and one day surgery) would allow to more easily open the ambulatory surgery to the patients currently excluded by the current system (ambulatory department open less than 12 hours).

Introduction: Ambulatory breast surgery is not well developed in France. This is especially true for oncologic procedures,Materials and methods: Between January 2005 and June 2006, we performed a retrospective evaluation of the factors thought to limit the development of this type of hospitalization.Results: The principal limiting factors were distance restrictions (respect of the 100km perimeter), the complexity of patient management for small breast tumors (several practitioners involved) and last, the non-motivating reimbursement policy.Conclusion: By changing to the Anglo-American ("one day surgery", i.e. hospital stay less than 24 hours) or hybrid system (less than 12 hours + 1 day surgery), ambulatory surgery could easily be offered to patients excluded by the current system (ambulatory department open less than 12 hours). (C) 2011 Elsevier Masson SAS. All rights reserved.

Background: After axillary lymphadenectomy for breast cancer, a suction drain is routinely inserted into the axilla to prevent seroma formation. This drain is an obstacle to reducing hospital stay after breast-conserving surgery. This was a prospective randomized clinical trial to assess the safety and results of axillary padding without the use of a drain.Methods: Between May 2001 and August 2003, 100 women were randomly allocated axillary padding without a drain or with the use of an axillary suction drain. Prospective assessments were made of morbidity, pain, shoulder mobility, quality of life and medical costs including length of hospital stay.Results: Using axillary padding significantly reduced the mean (s.d.) length of hospital stay (1.8(1) versus 4.5(2) days, P < 0.001). Postoperative complications, pain, shoulder mobility and quality of life were similar in the two groups. There was no difference in die duration of the two procedures.Conclusion: Axillary padding after axillary lymphadenectomy was feasible and safe, without a drain, and shortened hospital stay.

AIM:This study aimed to evaluate patient information provided, the management of post-operative symptoms and post-operative care, and patient satisfaction with ambulatory breast surgery over a 1-year period. METHODS:From January to December 2000, all breast cancer patients undergoing conservative breast surgery were offered surgery as an outpatient procedure at the Ambulatory Surgery Unit. RESULTS:Two hundred and thirty six patients underwent outpatient surgery. None were readmitted during the first night or the first week. Two hundred and nineteen patients completed a questionnaire. One hundred and sixty nine patients (group 1) underwent wide local excision (WLE) and 50 (group 2), WLE and axillary lymphadenectomy. Patients in group 2 experienced more pain at discharge from the hospital (p < or = 0.01) and during the first week after discharge (p < or = 0.00001) than patients in group 1. The mean overall satisfaction score was 8.97 on a scale of 1-10. Post-operative information provided by the surgeon before discharge from the hospital was rated 8.90 on a scale of 1-10 while information provided by the nurse was rated 9.33 (p < 0.0001). CONCLUSION:Ambulatory surgery for breast cancer patients is safe and popular with patients, however, post-operative pain presents problem.

La chirurgie senologique en ambulatoire en France est peu developpee. La prise en charge en ambulatoire est une bonne alternative a l'hospitalisation traditionnelle, pour la chirurgie diagnostique et conservatrice du cancer du sein. La morbidite operatoire, en dehors des lymphoceles axillaires n'est pas augmentee. L'acceptation de ce mode de prise en charge, pour les pa tientes informees, est bonne, le developpement de ce mode de prise en charge passe par une plus grande information des patientes et des medecins de ville, et par le developpement des diagnostics pre-therapeutiques. Il est important aujourd'hui de definir les indications et les limites de ce mode de prise en charge, en France, pour la chirurgie du cancer du sein.

The objective of this prospective study was to assess the feasibility of outpatient breast surgery, the reasons for inpatient procedures (IPP), the reasons for conversion and the conversion rate, and the postoperative morbidity after outpatient procedures (OPP).In 1999, among 625 patients eligible for OPP (diagnostic surgery or conservative curative surgery), OPP was performed in 418 patients (67%) and IPP was performed in 207 patients (33%). The reasons for IPP rather than OPP were environmental (64%) rather than medical (16%).The conversion rate to conventional surgery was 12.4% and the definitive OPP rate was 58.6%. The reasons for conversion were more often medical (50%) and environmental (21%) than surgical (23%). The morbidity, except for axillary seroma, was similar for OPP and IPP. The axillary seroma rate after axillary lymph node dissection was higher with OPP (27.4 vs 16.1%).OPP is a good alternative to IPP in breast surgery, especially for diagnostic purposes. OPP is also feasible for partial mastectomy with axillary lymph node dissection, but patients must be clearly informed about the risks of axillary morbidity. The patients' quality of life and satisfaction index should also be evaluated.