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Home:
Meeting
Highlights: 2000
Interactive Report
Outpatient
Surgery
34.
Do you ever perform, on an outpatient basis, . . .
A. axillary node dissection?
B. modified radical mastectomy?
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A
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B
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| Yes |
65%
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37%
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| No
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35%
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63%
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Patrick
Borgen, MD
Case A.
For a young, thin, healthy patient who has been instructed in her
drain care preoperatively, who spends five to six hours in a step-down
recovery unit —maybe longer —and goes home, that certainly
is an acceptable standard. And I would say in our practice, probably
60 percent of patients would spend the night, 40 percent would go
home the same day.
Case B.
Woman treated with mastectomy almost never go home the same day,
and there are lots of reasons for that. We deal with a huge amount
of psychological morbidity the next day. It is a physically and
mentally devastating operation, and we want to make sure we have
a handle on our patients 24-36 hours later. And so this idea of
the "drive-through mastectomy" is something we actively
fought in New York state and won. And we just about never do it.
Actually, I've never done it. For a woman who has a total mastectomy,
no nodes, she would stay one night. Modified radical, one to two
nights. Tissue expander — three nights. Tram flap —five
nights.
End-of-Life
Medical Care
35. Panelist
Dr Richard Margolese commented that many oncologists overutilize
chemotherapy in patients with advanced breast cancer. Non-oncologists
in the audience were asked, do you agree with Dr Margolese's statement?
Strongly agree 19% Agree 48% Disagree 31% Strongly disagree 2% Patrick
Borgen, MD That was a surprising moment in the conference. I don't
think that surgeons whom I know feel that medical oncologists over-utilize
therapies. I think that what you're trying to do is sell hope, and
if hope means that your doctor is going to give you a third and
a fourth line or a Phase 1 drug, far be it from anybody to take
that away.
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