A prospective evaluation of patients undergoing surgery for the palliation of an advanced malignancy.
BACKGROUND
Decisions regarding the use of surgical procedures for the palliation of symptoms caused by advanced malignancies require the highest level of surgical judgment. Prospective analysis of palliative surgical care may facilitate a more effective and representative evaluation of these patients.


METHODS
Patients requiring surgery planned solely for the palliation of an advanced malignancy were offered entry onto this study. Outcome measurements were made before surgery and monthly thereafter until the patient's death. Accepted techniques of pain assessment, quality of life, and functional status were used.


RESULTS
Between May 1997 and December 1999, 26 patients were enrolled. Although 46% (12 of 26) of patients demonstrated improvement in pain control or quality of life after palliative surgery, these benefits lasted a median of only 3.4 months. Palliative surgery was associated with significant postoperative complications in 35% (9 of 26) patients.


CONCLUSIONS
Although many patients had no apparent demonstrable benefit from surgery, surgeons were able to identify a group of patients who experienced significant benefits after a palliative procedure. The relationships between the patient and family members and the surgeon play an important role in decision-making throughout the palliative phase of cancer treatment.
Miner
Thomas J
TJ
General Surgery Service, Walter Reed Army Medical Center, Washington, DC, USA.
Jaques
David P
DP
Shriver
Craig D
CD
D004219:District of Columbia / Q000453:epidemiology; D006801:Humans; D009369:Neoplasms / Q000401:mortality / Q000601:surgery*; D010146:Pain; D010166:Palliative Care; D018579:Patient Selection; D010865:Pilot Projects; D011446:Prospective Studies; D011788:Quality of Life; D015996:Survival Rate