Marla, Veerabhadra Sekhar
Feasibility of day surgery for breast cancer in Glasgow.
MSc(R) thesis, University of Glasgow.
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Over the years, the surgical management of breast cancer has become less invasive due to various factors. Breast conserving surgery and lesser axillary surgery are performed whenever possible. Early stage at diagnosis made possible by breast screening and earlier presentation of symptomatic cancers due to increased awareness has meant that more patients are undergoing breast conserving surgery. Sentinel node biopsy and axillary sampling have helped reduce arm morbidity. These changes have made breast cancer surgery more amenable to day surgery. At the same time, the benefits of early discharge and day surgery have been increasingly recognised in all surgical specialities. In 2007, when this research was undertaken, majority of breast cancer patients in Glasgow underwent operations as inpatients.
The aims of this thesis were to establish the evidence base for day surgery in breast cancer and analyse the feasibility, acceptability and safety of performing day surgery in breast cancer patients in Glasgow.
In Chapter 2, a systematic review of literature for studies comparing day surgery with inpatient surgery in breast cancer is presented. This was undertaken to establish the present evidence. A randomised controlled trial is the gold standard when comparing one intervention with another. However, this systematic review revealed lack of any randomised controlled trials in literature comparing day surgery with inpatient surgery for breast cancer. Only observational studies were found and these showed day surgery for breast cancer to be safe with high patient satisfaction.
In Chapter 3, the feasibility of day surgery for breast cancer in Glasgow was examined. The postoperative length of hospital stay of patients undergoing surgery for breast cancer was studied across five centres in Glasgow. It was noted that 50 percent of patients were discharged within a day of their operation. An analysis of socio-demographic and clinico-pathologic factors influencing postoperative length of stay for all breast cancer surgical patients revealed that the most important factor influencing postoperative stay was the axillary procedure performed. It was seen that symptomatic cancer patients undergo more extensive surgery and are more likely to stay longer in hospital. Patients undergoing re-operations contributed 20 percent to the hospital bed utilisation. Fifty percent of the patients who were discharged within a day of their operation, were potentially thought to be suitable for day surgery.
In Chapter 4, the acceptability and safety of day surgery for breast cancer, evaluated in a pilot randomised controlled trial is presented. In this trial, day surgery was compared with inpatient surgery for patients undergoing breast conserving surgery with axillary sampling or sentinel node biopsy. Physical and psychosocial outcomes were examined using validated questionnaires. In a patient satisfaction survey, day surgery was found to be highly acceptable to patients. No difference was found in the physical outcomes between the two groups. Day surgery patients were noted to have a significantly better quality of life one week after their operation. Therefore, this trial found day surgery to be a safe option.
In conclusion, the results of the present thesis show that day surgery for breast cancer is a feasible option that was rated by the patients as highly acceptable and had better quality of life outcomes. Moreover, equivalent physical outcomes were noted in both the groups.
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