A prospective, symptom related, outcomes analysis of 1022 palliative procedures for advanced cancer.
OBJECTIVE
To prospectively evaluate surgical procedures performed with palliative intent.


BACKGROUND
There is a paucity of outcomes data necessary to allow sound surgical decision-making and informed consent for palliative procedures.


METHODS
Procedures to palliate symptoms of advanced cancer were identified prospectively from all operations performed. Patients were observed for >90 days or until death.


RESULTS
There were 1022 palliative procedures performed in 823 patients from July 2002 to June 2003. Operative (713/1022) or endoscopic (309/1022) procedures were performed for gastrointestinal obstruction (34%), neurologic symptoms (23%), pain (12%), dyspnea (9%), jaundice (7%) or other symptoms (15%). Symptom improvement or resolution within 30 days was achieved in 80% (659/823). Median duration of symptom control was 135 days. Recurrence of the primary symptom occurred in 25% (165/659) while treatment of debilitating additional symptoms was required in 29% (191/659). Palliative procedures were associated with 30-day postoperative morbidity (29%) and mortality (11%). A major postoperative complication reduced the probability of symptom improvement to 17%. Median survival was 194 days from the time of the palliative procedure and was adversely associated with poor performance status (ECOG > or = 2 [P < 0.001] or NCI fatigue score of > or =1 [P < 0.001]), poor nutrition (albumin <3.5 [P = 0.005] or significant weight loss [P = 0.003]), and no previous cancer therapy (P = 0.002).


CONCLUSIONS
In carefully selected patients, relief of symptoms following palliative procedures can be expected, but new or recurrent symptoms limit durability. Potential benefits are minimized by postoperative complications and are less predictable for patients with poor performance status, malnutrition and no prior cancer therapy.
Miner
Thomas J
TJ
Department of Surgery, Memorial-Sloan Kettering Cancer Center, New York, NY, USA.
Brennan
Murray F
MF
Jaques
David P
DP
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002493:Central Nervous System Diseases / Q000601:surgery; D004417:Dyspnea / Q000601:surgery; D004724:Endoscopy; D005221:Fatigue / Q000209:etiology; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007415:Intestinal Obstruction / Q000601:surgery; D007565:Jaundice / Q000601:surgery; D017567:Karnofsky Performance Status; D008297:Male; D044342:Malnutrition / Q000209:etiology; D008875:Middle Aged; D009369:Neoplasms / Q000601:surgery*; D010146:Pain / Q000601:surgery; D010166:Palliative Care; D011183:Postoperative Complications; D011446:Prospective Studies; D012008:Recurrence; D016019:Survival Analysis; D016896:Treatment Outcome; D015431:Weight Loss