title: Surgical palliation at a cancer center: incidence and outcomes.
abstract: OBJECTIVE
  Surgical intervention in palliative care is common; however, the indications, risks, and outcomes are not well described.
  
  
  METHODS
  Retrospective review of surgical cases during a 1-year period with a minimum 1-year survival update.
  
  
  METHODS
  A National Cancer Institute-designated comprehensive cancer center.
  
  
  METHODS
  Patients with a cancer diagnosis undergoing operative procedures.
  
  
  METHODS
  Number of palliative surgeries and analysis of length of stay, morbidity, and mortality.
  
  
  RESULTS
  Palliative surgeries comprised 240 (12.5%) of 1915 surgical procedures. There were 170 major and 70 minor procedures. Neurosurgical (46.0%), orthopedic (31.3%), and thoracic (21.5%) surgical procedures were frequently palliative. The most common primary diagnoses were lung, colorectal, breast, and prostate cancers. Length of hospital stay was 12.4 days (range, 0-99 days), with 21.3% of procedures performed on an outpatient basis. The 30-day mortality was 12.2%, with 5 patients dying within 5 days of their procedure. The overall mortality was 23.3% (56/240). Mortality for surgical procedures classified as major was 21.9% (44/170) and 10.0% (7/70) for those classified as minor (Fisher exact test, P<.01).
  
  
  CONCLUSIONS
  Significant numbers of palliative procedures are performed at our cancer center. Overall morbidity and mortality were high; however, a significant number of patients had short hospital stays and low morbidity. Palliative surgery should remain an important part of end-of-life care. Patients and their families must be aware of the high risks and understand the clear objectives of these procedures.
authors.affiliation: Southern Arizona Veterans Affairs Health Sciences and the University of Arizona, Surgical Care Line, 678/2-112, Tucson, AZ 85723, USA. Robert.Krouse@med.va.gov
authors.forename: R S
authors.initials: RS
authors.lastname: Krouse
authors.forename: R A
authors.initials: RA
authors.lastname: Nelson
authors.forename: B R
authors.initials: BR
authors.lastname: Farrell
authors.forename: B
authors.initials: B
authors.lastname: Grube
authors.forename: G
authors.initials: G
authors.lastname: Juarez
authors.forename: L D
authors.initials: LD
authors.lastname: Wagman
authors.forename: D Z
authors.initials: DZ
authors.lastname: Chu
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000401:mortality / Q000601:surgery*; D010166:Palliative Care / Q000379:methods* / Q000592:standards; D012189:Retrospective Studies; D012306:Risk; D012307:Risk Factors; D016019:Survival Analysis; D016896:Treatment Outcome