A prospective evaluation of palliative outcomes for surgery of advanced malignancies.
BACKGROUND
We prospectively evaluated the effectiveness of major surgery in treating symptoms of advanced malignancies.


METHODS
Fifty-nine patients were evaluated for major symptoms of intent to treat and were followed up until death or last clinical evaluation. Surgeons identified planned operations before surgery as either curative or palliative and estimated patient survival time. An independent observer assessed symptom relief. A palliative surgery outcome score was determined for each symptomatic patient.


RESULTS
Surgeons identified 22 operations (37%) as palliative intent and 37 (63%) as curative intent. The median overall survival time was 14.9 months and did not differ between curative and palliative operations. Surgical morbidity was high but did not differ between palliative (41%) and curative (44%) operations. Thirty-three patients (56%) were symptomatic before surgery, and major symptom resolution was achieved after surgery in 26 (79%) of 33. Good to excellent palliation, defined as a palliative surgery outcome score >70, was achieved in 64% of symptomatic patients.


CONCLUSIONS
Most symptomatic patients with advanced malignancies undergoing major operations attained good to excellent symptom relief. Outcome measurements other than survival are feasible and can better define the role of surgery in multimodality palliative care. A new outcome measure to evaluate major palliative operations is proposed.
McCahill
Laurence E
LE
Division of Surgical Oncology, University of Vermont, Burlington, Vermont, USA. larry.mccahill@vtmednet.org
Smith
David D
DD
Borneman
Tami
T
Juarez
Gloria
G
Cullinane
Carey
C
Chu
David Z J
DZ
Ferrell
Betty R
BR
Wagman
Lawrence D
LD
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003131:Combined Modality Therapy; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009017:Morbidity; D009369:Neoplasms / Q000601:surgery*; D010166:Palliative Care; D011379:Prognosis; D011446:Prospective Studies; D011788:Quality of Life; D016019:Survival Analysis; D016896:Treatment Outcome