Morbidity of emergency operations in patients with metastatic cancer receiving chemotherapy.
During a 5-year period, 21 patients with metastatic cancer receiving chemotherapy for periods ranging from 2 months to 5 years have required emergency abdominal operations. Symptoms in 15 indicated perforated viscus, whereas six developed massive, unremitting hemorrhage. All were operated upon with the sole intent of correcting the life-threatening problem, and every attempt was made to maintain or normalize physiologic parameters postoperatively. Despite this, 51 major complications occurred in 19 patients, and 17 died in the immediate postoperative period, 11 following multiple systems failure. Two died within 1 month of transfer to another hospital nearer home. A single patient lived 5 months at a nursing facility. The only survivor is living in a complete state of remission 9 months after discharge. No distinguishing features that might preoperatively predict which patient might survive emergency operation were found. The monetary cost of returning the sole survivor to society was over $500,000, discounting the emotional expenditure required of patients, families, and hospital staff. The dilemma the surgeon faces in making therapeutic decisions regarding such patients requires careful weighing of realities and the willingness to assume responsibility for the best possible choice in order to free the patient and family from agonizing deliberations.
D000006:Abdomen, Acute / Q000401:mortality / Q000601:surgery*; D000328:Adult; D000368:Aged; D000970:Antineoplastic Agents / Q000627:therapeutic use; D004630:Emergencies; D005260:Female; D005767:Gastrointestinal Diseases / Q000601:surgery; D006471:Gastrointestinal Hemorrhage / Q000601:surgery; D006801:Humans; D008297:Male; D008875:Middle Aged; D009362:Neoplasm Metastasis / Q000401:mortality; D009369:Neoplasms / Q000150:complications* / Q000188:drug therapy / Q000401:mortality; D011183:Postoperative Complications; D011184:Postoperative Period; D012422:Rupture, Spontaneous
D000970:Antineoplastic Agents